Option 1: Cardiac emergency

The patient appears uncomfortable. She is pale, diaphoretic, and clutching the center of her chest. While obtaining vital signs, the nurse says he's concerned about the patient and asks for your orders. The patient's blood pressure is 90/63 mm Hg, heart rate is 110 beats/minute, and oxygen saturation is 89% on room air. You call for the rapid response team and tell the nurse to start supplemental oxygen.

Question: What are you going to do next?

Make your choice, then click on the explanation bubble to reveal the answer.

• Ask the nurse to obtain another ECG.
• Obtain a detailed history from the patient.

Question: As the ECG is being obtained, what steps do you take to stabilize the patient?

While you wait for help to arrive, you can start taking the following steps.

• Follow the ABCDE approach.
• Perform a focused clinical evaluation and assess for red flags in chest pain.
• Establish IV access and obtain diagnostics for chest pain, including cardiac troponin levels.
• Evaluate and treat immediately life-threatening causes of chest pain.
• Initiate condition-specific treatment.

Check out the flowcharts below for a preview of how you and the rapid response team might proceed if the ECG shows a STEMI or signs of pulmonary embolism. For more detail, see “Management of chest pain.”

Consult cardiology immediately for management (e.g., emergency revascularization) of acute STEMI.

Reading an ECG quickly and correctly is an important skill to hone, since you'll often be the first one handed the ECG to rule out serious abnormalities. STEMI is a diagnosis you won't want to miss, and the faster you can diagnose it, the higher the likelihood of a good outcome for the patient.

ECG practice

Test your eyes on the following ECGs. Identify the pertinent findings, then apply the AMBOSS overlay to check your work.

You can also read up on ECG changes in STEMI, STEMI-equivalent ECG findings, ECG changes in NSTEMI/unstable angina, and high-risk ECG findings in PE.

Your quick actions give this patient a chance at the best possible outcome. Even so, serious causes of chest pain sometimes decompensate quickly to cardiac arrest. Prepare yourself to manage a lost pulse by reviewing the ACLS algorithm.

Related resources

• Acute coronary syndrome
• Myocardial infarction
• Cardiac arrest and cardiopulmonary resuscitation
• Pulmonary embolism

Want to explore the other scenario? Jump over to “Option 2: Chest pain with stable vital signs.” You can also return to the main module to wrap up “Achy breaky heart.”