I do hope so. I've "developed" my "MI sixth sense" through a LOT of experience. Get a doc to the bedside. Plug 'em in and line 'em up. A little O2 is only contraindicated in Paraquat ingestion...so I can rule that out pretty quick. Do the EKG, get a set of markers. A little ASA and close monitoring. If its nothing - well. If your patient is "doing it" - I have a better chance of seeing that your life gets saved!
When my beloved grandmother had a heart attack in 1994 - the ink on my paramedic certs was still drying, but... I credit one of my paramedic preceptors with the save. "IF you've got someone old, especially a woman, and they are sick and you don't know why - they are having a BIG OLE MI until you can prove they are not - got it?"
I got it.
I called my nana to go to the market when she told me she was "sick, sick, sick - had vomited and vomited and didn't feel good". Denied SOB, CP, chest pressure, jaw pain, headache - denied everything except for nausea and vomiting (sick). I immediately went to her house (2 blocks) where I found her sitting in the chair (looking like she might just die - yep, that COLOR - and she was also getting a fairly pronounced "bruise" on her forehead - she admitted that she was a bit weak and may have hit her head".)
Well, (this sounds stupid, but if I'd called from home - she'd argue) I left her to go to the local volunteer ambulance (I was a member of) to get supplies and get the dispatcher to sent me a truck/call a crew. I returned to her, placed O2, ASA, AED (Physio LP 500 - I know its an AED, but had a small screen - so I could monitor a Lead II - not really an approved use - this service had NOT transitioned to ALS service at that time). When the ambulance/other crew arrived I told her, "Nana, I'm gonna pick you up and put you on the stretcher - I think you are having a heart attack and we are going to the hospital and other paramedics will meet us soon". She started to protest, deny and weep (a little), but arguing with me is a futile activity - so off we went.
She recovered in spite of the the ER care she received. ("She's not having CP/SOB - I don't see the point of a cardiac work-up"...so I put her on the O2, monitor and insisted on the 12 lead". She had marked ST elevation on the AED and in the ED. Thank God I'm a bit pushy at times).
As a medic/nurse I've seen all kinds of presentations:
36 M - wanted all his teeth pulled "right now" (he had great teeth)
52 M that had posterior neck pain
45 M male that felt if he as being "stabbed" in the stomach
Variety of "older (65+)" folks that felt tired, weak - really NON SPECIFIC
My 40 ish cousin (dad had died at 50ish) c/o shoulder pain/abdomen pain, SOB, diaphoresis - writhing about in pain - did get some relief with Nitro, but his pressure would not hold - well, the ED (same one my nana went to 2 years earlier - 25 miles from home, but the only hospital - I'LL REFRAIN HERE) blew it, the ED doc "didn't think it could possibly be his heart" even with strong hx and some relief with NTG - he as admitted to surgery service (for GB disease) and died that night. His GB was great on autopsy. That was 1996 - Thank God the standard of care has evolved.
ANYWAY: The point is this ... Any clinical suspicion should set the CP process in motion. The cost of being wrong (no cardiac problem) is small - the cost of not properly treating the patient can be DEATH. I'm not advocating:
"EVERYONE ON A MONITOR - YOU DON"T HAVE THE RESOURCES"
but, when something exceeds the super obvious, you have to have a high clinical index of suspicion.
Any patient of certain age with family hx, risk factors that has sx above the knees! Also patients history cocaine, meth, crack or other drug use.
Male greater than 40 with classic sx (CP, SOB, Diaphoresis, etc)
Female (esp. post menopause) with classic or vague sx (esp. vomiting - without any known cause)
Any patient that had a lapse in consciousness.
Many patients with irregular pulses (you'd be surprised how many nurses NEVER palp a pulse - just check the monitor, pulse ox etc)
Patients that just don't look well.
In my experience, only a small % have the classic crushing, pressure pain with SOB. So stay sharp. I've been learning for 16 years and continue to do so. You experience does benefit the patient. Ask the doc's, other nurses - choose to LEARN!
In many patients, I always, at least, get the 12 lead unless I can find a reason NOT to. That is I need a better reason NOT to do something than I need a reason to do it! (That edict came from a medic preceptor too. It has saved me and lots of patients through the years)
Practice Safe. Stay Safe and Keep Learning!