›Time critical actions
›Cardiac monitor
›Pulse oximetry
›Blood pressure cycling
›IV access
›ECG within 10 minutes
›Point of care glucose when indicated
›Oxygen if SpO2 less than 90 percent
›Immediate cardiology activation for STEMI pattern
›Test pathway
›Serial ECG strategy
›Serial troponin strategy local protocol dependent
›Chest radiograph for alternate thoracic pathology
›PE pathway using Wells and PERC when appropriate
›Dissection pathway using risk features and CTA when indicated
›Suspected ACS
›Aspirin PO 160 mg to 325 mg chewed unless contraindicated
›Nitroglycerin SL 0.4 mg every 5 minutes
›Maximum 3 doses
›Avoid if SBP less than 90 mmHg
›Avoid if RV infarct concern
›Avoid if PDE5 inhibitor use
›Analgesia if persistent pain
›Fentanyl IV 25 mcg to 50 mcg titrated
›Avoid hypotension
›Anticoagulation and P2Y12 local protocol dependent
›Suspected PE
›Anticoagulation if high suspicion and low bleeding risk local protocol dependent
›Thrombolysis pathway for massive PE local protocol dependent
›Oxygen targets SpO2 92 percent or higher
›Suspected aortic dissection
›Immediate CTA if stable enough
›Pain control with opioid titration
›HR control target 60 or less local protocol dependent
›Esmolol IV bolus and infusion local protocol dependent
›SBP target 100 mmHg to 120 mmHg local protocol dependent
›Nicardipine infusion if needed local protocol dependent
›Pericarditis pattern
›NSAID therapy local protocol dependent
›Colchicine local protocol dependent
›Avoid anticoagulation if large effusion concern
Monitoring and reassessment loop
›Reassessment cadence
›Repeat vitals within 30 minutes for unstable features
›Repeat pain score after interventions
›Repeat ECG with symptom change
›Escalate level of care if rising oxygen need
›Specialty triggers
›Cardiology for ischemia pattern
›CT surgery or vascular for dissection concern
›Pulmonary or ICU for massive PE concern
›GI or surgery for esophageal rupture concern