NICE guidelines for the management of patients with acute chest pain
Chest pain Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
NICE guidelines for the management of patients with acute chest pain On the Web |
FDA on NICE guidelines for the management of patients with acute chest pain |
CDC on NICE guidelines for the management of patients with acute chest pain |
NICE guidelines for the management of patients with acute chest pain in the news |
Blogs on NICE guidelines for the management of patients with acute chest pain |
to Hospitals Treating NICE guidelines for the management of patients with acute chest pain |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Priyamvada Singh, M.B.B.S. [3]
Overview
The American College of Cardiology, American Heart Association,and National Institute for Health and Clinical Excellence (NICE) guidelines recommends performance of ECG for all patients with cardiac chest pain. Additionally, chest X-rays in patients with suspected congestive heart failure, aortic dissection, aortic aneurysm, valvular heart disease, pericardial disease. However, the guidelines recommend exercise testing in low and intermediate risk patients only after they have been screened for high risk features and other indications for hospital admission.
NICE guidelines for the management of patients with acute chest pain (DO NOT EDIT) [1]
“ |
Initial Assessment and Referral to Hospital
Resting 12-Lead ECG
Immediate Management of a Suspected Acute Coronary Syndrome Management of ACS should start as soon as it is suspected, but should not delay transfer to hospital. The recommendations in this section should be carried out in the order appropriate to the circumstances. Offer pain relief as soon as possible. This may be achieved with glyceryl trinitrate (GTN) (sublingual or buccal), but offer intravenous opioids such as morphine, particularly if an acute myocardial infarction (MI) is suspected. Offer people a single loading dose of 300 mg aspirin as soon as possible unless there is clear evidence that they are allergic to it. If aspirin is given before arrival at hospital, send a written record that it has been given with the person. Only offer other antiplatelet agents in hospital. Follow appropriate guidance (see the NGC summary of the NICE clinical guideline Unstable angina and NSTEMI) or local protocols for STEMI). Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission. Only offer supplemental oxygen to: People with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2 of 94–98% People with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88–92% until blood gas analysis is available. Monitor people with acute chest pain, using clinical judgment to decide how often this should be done, until a firm diagnosis is made. This should include: Exacerbations of pain and/or other symptoms Pulse and blood pressure Heart rhythm Oxygen saturation by pulse oximetry Repeated resting 12-lead ECGs and Checking pain relief is effective Manage other therapeutic interventions using appropriate guidance (see the NGC summary of the NICE clinical guideline Unstable angina and NSTEMI) or local protocols for STEMI). |
” |