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What is How do we Immediately manage a suspected acute coronary  and explain in detail?
Offer pain relief as soon as possible. This may be achieved with GTN (sublingual or buccal), but offer intravenous opioids such as morphine, particularly if an acute myocardial infarction is suspected. Offer people a single loading dose of 324 mg aspirin as soon as possible unless there is clear evidence that they are allergic to it. If aspirin is given before arrival at hospital, send a written record that it has been given with the person. Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission. Only offer supplemental oxygen to: people with oxygen saturation (SpO 2 ) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO 2 of 94-98% people with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88-92% until blood gas analysis is available. Take a resting 12-lead ECG as soon as possible. When people are referred, send the results to hospital before they arrive if possible. Recording and sending the ECG should not delay transfer to hospital. A number of changes on a resting 12-lead ECG are consistent with CAD and may indicate ischaemia or previous infarction. These include: 1. pathological Q waves in particular 2. LBBB 3. ST-segment and T wave abnormalities (for example, flattening or inversion). Note that the results may not be conclusive. Consider any resting 12-lead ECG changes together with peoples clinical history and risk factors. If a ST segment elevation is detected, the patient should be immediately referred to hospital, as in these patients Monitor people with acute chest pain, using clinical judgement to decide how often this should be done, until a firm diagnosis is made. This should include: 1. exacerbations of pain and/or other symptoms 2.  pulse and blood pressure 3. heart rhythm 4. oxygen saturation by pulse oximetry 5.  repeated resting 12-lead ECGs 6.  checking pain relief is effective.