Establish the Airway

Step 1. Check if the patient can speak clearly:

  • If the patient is talking normally โ†’ the airway is patent.

  • If the patient cannot speak, is gasping, or there are gurgling/stridor sounds โ†’ airway may be compromised.

๐Ÿ”น Step 2: Perform Basic Airway Opening Maneuvers

If airway obstruction is suspected or the patient is unresponsive:

  1. Head-Tilt/Chin-Lift

    • Used if there is no suspicion of trauma.

    • Tilt the head back gently and lift the chin upward to open the airway.

  2. Jaw-Thrust Maneuver

    • Used if trauma (especially cervical spine injury) is possible.

    • Place fingers behind the angles of the mandible and lift the jaw forward without tilting the head.

๐Ÿ”น Step 3: Clear the Airway

  • Remove visible obstructions (vomitus, blood, dentures) with suction or a finger sweep (only if visible).

  • Use oropharyngeal (OPA) or nasopharyngeal airway (NPA) if the patient is unconscious and cannot maintain their airway.

๐Ÿ”น Step 4: Provide Supplemental Oxygen

Even if the airway is clear:

  • Give oxygen via nasal cannula (2โ€“4 L/min) for mild distress.

  • If hypoxic or unstable โ†’ use a non-rebreather mask (10โ€“15 L/min).

     

๐Ÿ”น Step 5: Advanced Airway (if needed)

If the patient cannot maintain airway patency or oxygenation is inadequate, escalate to:

  • Bag-valve-mask (BVM) ventilation.

  • Endotracheal intubation

  • Supraglottic airway (LMA) as an alternative if intubation fails.

     

๐Ÿ”น Special Considerations in Chest Pain

Patients with chest pain (e.g., myocardial infarction) often have:

  • Anxiety and tachypnea โ€” keep them calm and ensure oxygenation.

  • Risk of cardiac arrest โ€” prepare for airway and resuscitation measures immediately.

  • Avoid hyperventilation โ€” excessive oxygen or ventilation can worsen ischemia in some cases.

๐Ÿ”น Quick Summary (ABCDE approach start)

Step Action Purpose
A Assess and secure airway Ensure oxygen entry
B Assess breathing (rate, effort, Oโ‚‚ sat) Detect distress, hypoxia
C Monitor circulation (pulse, BP, ECG) Identify cardiac cause
D Check disability (GCS, responsiveness) Identify CNS cause
E Expose chest (inspect, palpate, auscultate) Detect trauma or abnormal sounds

Would you like me to include a flowchart or algorithm showing the airway management steps specifically for chest pain emergencies (e.g., cardiac arrest vs. non-arrest)?

Here’s a clinical decision algorithm / flowchart for evaluating and managing an unstable patient with chest pain โ€” designed for rapid bedside use (ER, ICU, or ACLS context):

โš•๏ธ Algorithm: Unstable Patient with Chest Pain

Step 1: Immediate Assessment (Simultaneous ABCs)

๐Ÿฉธ A โ€“ Airway:
โ†’ Assess patency โ†’ Secure if obstructed or GCS < 8

๐ŸŒฌ B โ€“ Breathing:
โ†’ Check rate, effort, Oโ‚‚ saturation
โ†’ Provide oxygen (target SpOโ‚‚ > 94%)
โ†’ Look for asymmetry โ†’ If absent breath sounds + hypotension โ†’ Tension pneumothorax โ†’ Needle decompression immediately

โค๏ธ C โ€“ Circulation:
โ†’ Check pulse, BP, perfusion
โ†’ Attach cardiac monitor & obtain 12-lead ECG (within 10 min)
โ†’ Establish 2 large-bore IV lines
โ†’ Draw labs (CBC, troponin, electrolytes, coagulation)
โ†’ If hypotensive โ†’ Start IV fluids, then vasopressors if no response

Step 2: Rapid Life-Threatening Differential (5 Killers)

Condition Key Findings Diagnostic Clues (Bedside) Immediate Action
Myocardial Infarction (ACS) Pressure-like pain, diaphoresis, radiation to arm/jaw ECG changes, โ†‘ Troponin MONA (Morphine, Oxygen, Nitrates, Aspirin), urgent PCI
Pulmonary Embolism (Massive) Sudden dyspnea, pleuritic pain, hypotension Tachycardia, RV strain on echo Anticoagulate / thrombolyse if massive
Aortic Dissection Tearing pain to back, unequal arm BPs Widened mediastinum on CXR, bedside echo or CTA BP control (ฮฒ-blocker โ†’ vasodilator), surgical call
Tension Pneumothorax Sudden pleuritic pain, tracheal deviation, distended neck veins Absent breath sounds Immediate needle decompression
Cardiac Tamponade JVD + muffled heart sounds + hypotension (Beck’s triad) Echo: pericardial effusion, RV collapse Pericardiocentesis

Step 3: Focused Bedside Investigations

  • ๐Ÿซ€ 12-lead ECG โ€“ MI or ischemia?

  • ๐Ÿฉป Portable chest X-ray โ€“ pneumothorax, mediastinum, CHF

  • ๐Ÿ”ฆ Bedside echo (POCUS) โ€“ tamponade, LV dysfunction, RV strain

  • ๐Ÿงช Labs โ€“ Troponin, CBC, electrolytes, coagulation, ABG, D-dimer (if stable enough)

Step 4: Immediate Management Bundle

  • Aspirin 325 mg (unless contraindicated)

  • Oxygen (if SpOโ‚‚ < 94%)

  • Nitroglycerin (avoid in hypotension or RV infarct)

  • Morphine (for severe pain/anxiety)

  • Cardiac monitoring continuously

  • Treat the identified cause (e.g., PCI, thrombolysis, decompression, pericardiocentesis)

Step 5: If Still Unstable โ†’ Use Focused Algorithm

If Hypotension Persists:

  • Evaluate for:

    • Cardiogenic shock (MI, tamponade) โ†’ Echo-guided fluids, inotropes

    • Obstructive shock (PE, pneumothorax) โ†’ Relieve obstruction

    • Distributive shock (sepsis) โ†’ IV fluids + antibiotics

    • Hypovolemic (rupture, trauma) โ†’ Volume resuscitation

Step 6: Secondary Evaluation (After Stabilization)

  • Full history and physical

  • Serial ECGs + Troponins (rule out evolving MI)

  • Advanced imaging (CT-A chest, coronary angiography) as tolerated

  • Admit to ICU or coronary care unit (CCU) for continuous monitoring

Would you like me to generate a visual flowchart diagram (infographic-style) version of this algorithm โ€” suitable for emergency reference or training slides?

 

 

 

Management and Determining the Cause

Digital World Medical School
ยฉ 2025