Cardiac ischaemia
If the patient is unconscious, signs of cardiac ischaemia primarily include: ST elevation or depression; T wave flattening or inversion; arrhythmias, particularly ventricular; other haemodynamic abnormalities (hypo- or hypertension, tachy- or bradycardia); new or evolving regional wall motion abnormalities if echocardiography is used. If the patient is conscious, symptoms may include chest pain, breathlessness, dizziness, nausea and vomiting. Have a high index of suspicion in patients with a pre-existing history or risk factors for cardiac ischaemia.
Cardiac arrest → 2-1
Hypotension → 2-4
Hypertension → 2-5
Bradycardia → 2-6
Tachycardia → 2-7
Right arm (red) lead over upper right sternum.
Left arm (yellow) lead 5th intercostal space under left nipple.
Indifferent (green or black) lead on left shoulder.
Consider sublingual administration.
i.v.: 1 mg.ml⁻¹ solution – start at 0.1 ml.kg⁻¹.hr⁻¹, titrate against response.
NOT RECOMMENDED IN CHILDREN.
Admit to critical care environment and consult cardiology.
Maintain head up position if practicable.
Obtain serial 12-lead ECGs and cardiac enzymes.