Give supplemental oxygen if SpO₂ < 90%, or if patient is dyspneic or in distress.
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Establish Circulation
Palpate the carotid or radial pulse.
2. If No Pulse — Treat as cardiac arrest:
Start CPR
3. If Pulse Is Present — Support Circulation
Attach Cardiac Monitor to Patient.
. Monitor blood pressure, heart rate, and oxygen saturation
Insert IV access (preferably two large-bore lines).
Obtain a 12-lead ECG within 10 minutes of arrival.
💊 4. Address the Cause
If the patient is stable, treat the underlying cause of poor circulation:
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Myocardial infarction (MI):
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Administer aspirin (chew 162–325 mg) immediately.
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Give nitroglycerin (if not hypotensive and no RV infarct).
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Prepare for reperfusion therapy (PCI or thrombolysis).
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Cardiac arrhythmia:
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Identify via ECG and manage per ACLS algorithm (e.g., bradycardia → atropine, tachyarrhythmia → synchronized cardioversion or antiarrhythmics).
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Cardiogenic shock:
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Support with inotropes (e.g., dobutamine) and consider mechanical support (IABP, Impella) if refractory.
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🧠 5. Ongoing Monitoring
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Reassess vital signs and perfusion frequently.
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Continue cardiac monitoring for rhythm changes or deterioration.
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Prepare for advanced cardiac life support if cardiac arrest occurs.
Would you like me to include a flowchart (algorithm) showing the steps for assessing and establishing circulation in chest pain (both with and without pulse)?
Here’s a clear algorithmic flowchart for establishing circulation in a patient with chest pain, covering both situations — with pulse and without pulse:
🫀 Circulation Algorithm in Chest Pain
START → Patient with Chest Pain │ ▼ Check Responsiveness │ ┌──────────┴──────────┐ │ │ Unresponsive Responsive │ │ ▼ ▼ Check Pulse Assess Circulation (Carotid or Radial) (Pulse, BP, Perfusion) │ │ ▼ ▼ ┌────────────┐ ┌────────────────────┐ │Pulse Absent│ │Pulse Present │ └──────┬─────┘ └────────┬───────────┘ │ │ ▼ ▼ 🚨 Begin CPR ✅ Establish IV Access (30:2 ratio) and Cardiac Monitoring │ │ ▼ ▼ Attach AED/Monitor Obtain 12-Lead ECG │ │ ▼ ▼ Check Rhythm: Assess BP, SpO₂, Skin, VF/VT? → Shock Capillary Refill Asystole/PEA? → CPR │ │ ▼ Follow ACLS Protocol ┌────────────────────────┐ │Is SBP < 90 mmHg or │ │signs of poor perfusion?│ └─────────┬──────────────┘ │ ┌─────────────┴─────────────┐ │ │ YES NO │ │ ▼ ▼ Give IV Fluids (250–500 mL NS) Continue Monitoring If Pulmonary Congestion → Skip and Manage Pain/Anxiety Consider Vasopressor (NE) │ │ │ ▼ ▼ Treat Underlying Cause Treat Underlying Cause (e.g., MI, arrhythmia, shock) (ACS, anxiety, musculoskeletal) │ │ ▼ ▼ **Stabilize Circulation** → Reassess Vital Signs │ ▼ Prepare for Definitive Care (PCI, Thrombolysis, Advanced Support)
🧩 Key Points:
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Always secure IV access early (two large-bore lines).
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Monitor ECG and SpO₂ continuously.
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Avoid nitroglycerin if hypotensive or right ventricular infarction is suspected.
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Reassess every few minutes — patient may deteriorate rapidly.
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If cardiac arrest develops, immediately transition to ACLS.