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

  1. ECG
    • All ECGs must be interpreted and signed by a senior medical officer (FACEM or Registrar) within 10 minutes.
    • repeated at 0 & 2 hours
  2. clinical risk assessment (see below)
  3. serial troponin testing
    • perform at 0 & 2 hours
    • positive if >14ng/L at any time
    • positive if delta trop >5ng/L at any time:
Patients with neither HIGH or LOW clinical risk criteria are considered INTERMEDIATE risk

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.