What are the immediate management steps for a patient presenting with suspected myocardial infarction in primary care?

Immediate management steps for a patient presenting with suspected myocardial infarction (MI) in primary care:

• Call emergency services immediately for urgent hospital transfer; do not delay transfer for investigations or treatment in primary care ¹.
• Administer a single loading dose of 300 mg aspirin orally as soon as possible unless there is a clear allergy to aspirin; document administration and inform hospital staff ¹,².
• Offer pain relief promptly, typically with sublingual or buccal glyceryl trinitrate (GTN); consider intravenous opioids such as morphine if acute MI is strongly suspected and pain is severe ¹.
• Take a resting 12-lead ECG as soon as possible if it does not delay transfer; send the ECG to hospital if feasible ¹.
• Monitor vital signs continuously including pulse, blood pressure, heart rhythm, oxygen saturation by pulse oximetry, and pain severity until hospital admission ¹.
• Do not routinely administer oxygen; only give supplemental oxygen if oxygen saturation is below 94% (or 88-92% in patients at risk of hypercapnic respiratory failure) aiming for target saturations of 94-98% or 88-92% respectively ¹.
• Prepare for hospital handover by recording clinical history, treatments given, and observations to facilitate rapid specialist assessment ¹.