General Overview:

Differential diagnosis of non-traumatic chest pain is challenging.  Therefore any patient exhibiting signs and symptoms of chest pain that cannot be attributed to a non-cardiac origin, should be managed as if the origin is cardiac.  Younger people may complain of rapid uncontrolled heart rate without chest pain.

Treatment for Cardiac Emergencies:

  1. Reduce anxiety and activity.  Place patient in a position of comfort.  Avoid walking if possible.
  2. Administer high-flow/high-concentration oxygen, if available.
  3. Assist patient with administration of his or her nitroglycerin, 0.4mg SL spray or tablet, may be repeated every 5 minutes for a total of three doses if the systolic BP remains above 90mmHg.  
  4. Administer one-half adult aspirin (160mg) or two baby aspirin (8lmg each) every 24 hours.

Evacuation Guidelines for Cardiac Emergencies:

Evacuate Rapidly:

  • Any patient with chest pain that does not relieve within 20 minutes.


  • Any patient with non-traumatic chest pain that subsided with rest or medication.
  • Any patient with sustained periods of rapid heart rate.


ACLS Provider Manual.  Dallas, Texas: American Heart Association, 2002.

BLS for Healthcare Providers.  Dallas, Texas: American Heart Association, 2002.

“Cardiac/Circulatory.” United States Special Operations Command.  Special Operations Forces Medical Handbook.  Jackson, Wyoming: Teton NewMedia, 2001. 4-1.

Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <>

Schimelpfenig, Tod and Linda Lindsey.  “Respiratory and Cardiac Emergencies, Seizures, Diabetes and Unconscious States.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 18.

The Merck Manual 16th Edition.  Rathaway, New Jersey: Merck & Co., Inc., 1992.

Tilton, Buck.  “Cardiac Emergencies.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 23.

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