What are the immediate management steps for a patient presenting with

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 .
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 ,.
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 .
Take a resting 12-lead ECG as soon as possible if it does not delay transfer; send the ECG to hospital if feasible .
Monitor vital signs continuously including pulse, blood pressure, heart rhythm, oxygen saturation by pulse oximetry, and pain severity until hospital admission .
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 .
Prepare for hospital handover by recording clinical history, treatments given, and observations to facilitate rapid specialist assessment .

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