Paramedic Diagnosis of Acute Coronary Syndrome in the Out-of-Hospital Patient with Acute,Non-Traumatic Chest Pain: The RSVP 3 Heart Exam

Abstract

Background

The accurate diagnosis of acute coronary syndrome in the out-of-hospital patient experiencing acute, not-traumatic chest pain remains an important challenge both clinically and financially. As both a high frequency and high impact occurrence, it is rightly considered to be a high-risk situation.

Methods

In order to recommend an evidence-based approach to paramedic diagnosis of this condition, the author conducted a scoping study, reviewing over 70 sources relevant to the topic from 1984 to 2015, and then summarised the findings.

Results

The evidence suggests that most of the current methods taught to paramedics to identify acute coronary syndrome patients are not in accord with findings that have been reported in the literature over the past 20 years. Areas where current teaching is not in accord with the evidence are highlighted, traditionally taught assessments that are non-diagnostic are identified, and those that are most diagnostic are listed and explained.

Conclusion

Research suggests that paramedics follow the HEART assessment (History, EKG, Age, Risk factors, Troponin) and this work offers a novel, evidence-based method to assess the patient's history using the acronym RSVP3 (Radiation, Similarity, Variation, Pleuritic, Positional, Palpation), which is meant to replace other commonly used, but non-diagnostically sensitive, acronyms such as OPQRST, DOLOR, SOCRATES and CHEST PAIN. An emphasis is also placed on performing a thorough physical examination and so the novel mnemonic ‘RSVP₃ Heart Exam’ is introduced. Evidence to support these recommendations is given.