What are the key assessment steps for a patient presenting with chest pain in an emergency setting?

Key assessment steps for a patient presenting with chest pain in an emergency setting:

• Initial clinical assessment: Check immediately if the patient currently has chest pain or when the last episode occurred, especially if within the last 12 hours ².
• History taking: Take a detailed clinical history including characteristics of the pain (location, radiation, severity, duration, frequency, provoking and relieving factors), associated symptoms (e.g., breathlessness, nausea, sweating), history of cardiovascular disease, and cardiovascular risk factors ².
• Physical examination: Assess haemodynamic status (blood pressure, pulse rate, respiratory rate), oxygen saturation, level of consciousness, and signs of complications such as pulmonary oedema or other cardiovascular or non-coronary causes (e.g., aortic dissection) ¹,².
• Electrocardiogram (ECG): Perform a resting 12-lead ECG as soon as possible and send the recording with the patient if transfer to hospital is needed. Repeat ECGs may be necessary ¹,².
• Oxygen saturation monitoring: Monitor oxygen saturation using pulse oximetry. Do not routinely administer oxygen; only give supplemental oxygen if saturation is below 94% (or 88-92% in COPD patients at risk of hypercapnic respiratory failure) ¹,².
• Immediate management: If acute coronary syndrome (ACS) is suspected, give aspirin 300 mg unless contraindicated, and offer pain relief with glyceryl trinitrate (GTN) and/or intravenous opioids (e.g., diamorphine) ¹,².
• Urgent referral/admission: Refer patients urgently to hospital if ACS is suspected and they have current chest pain, or had chest pain in the last 12 hours with abnormal or unavailable ECG. Admit patients with clinical features suggesting serious causes (e.g., tachycardia >130 bpm, hypotension, oxygen saturation <92%, altered consciousness) ¹,².
• Monitoring: Continuously monitor pain, vital signs, heart rhythm, oxygen saturation, and effectiveness of pain relief until diagnosis is confirmed ¹,².