For suspected acute coronary syndrome in the field, which action is appropriate?

• A. Continuous monitoring, provide oxygen if needed, administer aspirin if protocol allows and no contraindications, and transport rapidly
• B. Administer intravenous fluids immediately to all patients
• C. Delay transport to perform a hospital ECG first
• D. Place the patient in Trendelenburg position

Answer: (A)

In suspected acute coronary syndrome, the priority is to keep the patient stable and get them to definitive care quickly. You should monitor the patient continuously, provide oxygen only if they are hypoxic or in distress, and give aspirin per protocol if there are no contraindications (usually a chewed dose to help with platelet inhibition). Transport to a facility capable of advanced care as rapidly as possible, and if available, perform or transmit a field ECG to aid hospital preparation without delaying transport. Do not delay transport for a hospital ECG, and avoid routine IV fluid boluses or positioning the patient in Trendelenburg, unless there are other clear indications per protocol. This approach focuses on early recognition, stabilization, and timely access to reperfusion therapy when appropriate.