Chest pain offenders are a phenomenon any correctional nurse is all too familiar with! I will preface my answer with one very huge tip; if you are even marginally unsure as to what disposition to give to a patient who comes in with chest pain--FOLLOW PROTOCOL. CA corrections has created an environment that emphasizes protocol due to the litigation it has gotten itself into. Furthermore; as nurses we are not able to diagnose and in turn are not able to rule out diagnoses. It is always in a nurse's best interest to ASSESS and gather as much information as possible regarding the chest pain and give it to the doctor on call; let the MD make the disposition and document/track your communication. The last thing a nurse ever wants is treat a cardiac event as chest wall pain and dismiss him to the unit back to the yard.
I once had an inmate who was AOx3, calm, able to verbalize full sentences cooperative, zero shortness of breath, CMS intact, ambulatory--the whole 9. 12Lead showed ST elevation on anterior V2-V3-V4 (get very comfortable with the 12Lead). We sent him to the hospital for observation and a full work up.
I also had an inmate who came in c/o CP, SOB, diaphoretic, obtunded, etc. Vitals WDL 12Lead intact, kept him in our triage area until I could get an MD to sign off on his 12Lead and give me the okay to treat him with RN protocols.
There will be some RNs who feel comfortably making dispositions, but I don't personally share their approach. I'd rather not gamble my license by playing doctor regardless of how many cardiac patients I've had in my career.
Long story short. If you get a chest pain. ASSUME MI until you can have an MD/NP sign off and make a disposition for you. Until then, do the whole bit, whatever the protocol on your post says. 02, ASA, Nitro, 12Lead, start an IV if you can. The worst thing you can do is get an MD grumpy for "wasting his/her time with chest wall pain." I've noticed most MD's are great in handling these situations if you have gathered all the information for them. Get vitals, get a quick history, get him on a monitor and be able to describe simple waveforms (STEMI or no STEMI?, if STEMI, what leads?), have access ready if you can.
I know it's a lot, and especially when it happens frequently; but the more you do it the faster you will be and the more comfortable you will be making your own dispositions in the future (I've ruled out C/P as some obvious chest wall pain a few times). Encourage your pt to be a good historian; was an injury involved? did they just do 100 push ups? Push on their pecs, have them do ROM and see if it gets worse/better with movements. If you're ever in doubt, though--just follow protocol!