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Acute CoronarySyndromesN60BSpring 201512Case ScenarioA 55-year-old man presents with a chief complaint of severe (10 out of 10) substernal chest pain. He has pain radiating down his left arm and up into his jaw, nausea, and a profound sense of impending doom. He is covered with small beads of sweat.Vital signs: TEMP = 37.2C; HR = 110 bpm; BP = 150/100 mm Hg; RESP = 12Describe your immediate assessment.Describe your immediate general treatment.

2The history in this first case should be classic, with all elements of the textbook acute heart attack. Later cases can be used to point out the large variety of ways in which acute coronary syndromes present.ACLS provider trainees should be taught to apply the 1-to-10 pain scale commonly used in prehospital care.Trainees should be taught the importance of recording the time of pain onset. This is relevant to later decisions about thrombolytic therapy and primary PTCA.

3Items of Immediate Assessment (