Prehospital Management
ÎÎPatients with symptoms that may represent ACS (Table 2) should not
be evaluated solely over the telephone but should be referred to a
facility that allows evaluation by a physician and the recording of a 12lead ECG and biomarker determination (eg, an emergency department
[ED] or other acute-care facility). (I-C)
ÎÎPatients with symptoms of ACS (chest discomfort with or without
radiation to the arm[s], back, neck, jaw, or epigastrium; shortness of
breath; weakness; diaphoresis; nausea; lightheadedness) should be
instructed to call 9-1-1 and should be transported to the hospital by
ambulance rather than by friends or relatives. (I-B)
ÎÎHealth care providers should actively address the following issues
regarding ACS with patients with or at risk for CHD and their families
or other responsible caregivers:
• The patient's heart attack risk (I-C)
• How to recognize symptoms of ACS (I-C)
• The advisability of calling 9-1-1 if symptoms are unimproved or worsening after
5 min, despite feelings of uncertainty about the symptoms and fear of potential
embarrassment (I-C)
• A plan for appropriate recognition and response to a potential acute cardiac
event, including the phone number to access emergency medical services
(EMS), generally 9-1-1. (I-C)
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