All patients presenting to the ED with chest pain or other symptoms of myocardial ischemia will be commenced on the NSW Health PACSA pathway.
** ordering a troponin should trigger you to use this pathway **
Initial management includes 300mg aspirin, and GTN titrated to pain and blood pressure.
Risk assessment is based on
- ECG
- All ECGs must be interpreted and signed by a senior medical officer (FACEM or Registrar) within 10 minutes.
- repeated at 0 & 2 hours
- clinical risk assessment (see below)
- serial troponin testing
- perform at 0 & 2 hours
- positive if >14ng/L at any time
- positive if delta trop >5ng/L at any time:
Disposition
- Low risk chest pain patients should be referred to EST clinic within 7 days (phone 9540 7889 and leve a message for cardiology secretary to contact the patient)
- Intermediate risk chest pain patients should be referred to the cardiology team for further assessment – a second troponin is not required prior to referral.
- High risk chest pain patients will require admission. Anti-coagulation, anti-platelet therapy, beta-blocker and statin as per cardiology advice.