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Cardiac Emergencies Including Angina, AMI and Cardiac Arrest
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Heart disease is the leading cause of death in the United States. One person dies every 34 seconds from cardiovascular disease.
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| Indication | Signs and Symptoms | Medication | Dosage & Route |
|---|---|---|---|
| Chest Pain Angina | Conscious *Preexisting history of angina *Patient will make diagnosis of angina Tightness in chest 'Usual' radiation pattern (commonly left arm, neck & mandible) 1st time chest 'pain' always assume AMI | Nitroglycerin Sublingual Tablet(s) or Translingual Spray | Nitro: Every 5 Minutes as Needed, Maximum of 3 Doses Oxygen: 15 Liters/Minute |
| Chest "Pain" Acute Myocardial Infarction | Conscious Tightness in chest Commonly radiates to left arm, neck, and mandible 'Crushing' pain (elephant standing on chest) Anginal patient 'knows' it's not angina Possible loss of conciousness First time chest pain: Always assume AMI | Aspirin 325 mg (Powdered with Water or Chewable), Unless Allergic | Aspirin: Administer Quickly Oxygen: 15 Liters/Minute If N₂O-O₂ available: Administer 50% N₂O and O₂ |
| Cardiac Arrest Unconscious No Breathing No Pulse | Unconcious No breathing No pulse | None | Begin CAB and retrieve AED |
Position comfortably—usually upright preferred.
Ensure the patient is in a comfortable position before proceeding.
Administer nitroglycerin.
Depending on preference and availability, administer nitroglycerin sublingual tablet(s) or translingual spray. Repeat nitroglycerin every 5 minutes for a maximum of 3 doses if needed.
Provide oxygen.
Monitor and record patient vital signs.
Check important vital signs, including BP, O₂ saturation, and respiratory rate.
Continue monitoring.
Allow patient to rest while you continue to determine the cause of the acute episode. If this is their first chest “pain”, proceed to acute myocardial infarction (AMI) protocol.
Position comfortably—usually upright preferred.
Ensure the patient is in a comfortable position before proceeding.
Contact EMS.
Before beginning any procedures, contact EMS immediately.
Provide oxygen.
Deliver oxygen at a rate of 15 liters per minute to the patient.
Administer N₂O-O₂ if available.
Give the patient N₂O-O₂ at a rate of 50% N₂O and 50% O₂.
Start Aspirin regimen.
Provide the patient with Aspirin 325mg (powdered with water or chewable), unless allergic.
Monitor and record patient vital signs.
Check important vital signs, including BP, O₂ saturation, and respiratory rate.
Continue monitoring.
If a patient loses consciousness, proceed to cardiac arrest protocol.
Position supine with feet elevated.
For dentists, you may keep the patient seated if in a dental chair. In all cases, position them supine with their feet elevated.
Contact EMS.
Before beginning any procedures, contact EMS immediately.
CAB: Compressions, Airway and Breathing
Complete cycles of 30 compressions and 2 ventilations.
Retrieve AED.
While continuing CAB, retrieve the AED, place the pads on the patient’s chest according to the instructions provided with the device, and active it as quickly as possible.
Continue CAB and AED Cycles.
Get the Guide: Management of Medical Emergencies by Dr. Stanley Malamed, DDS
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