Critical decision making in the management of patients with acute myocardial infarction and other acute coronary syndromes.

The decision-making process for emergency physicians in managing patients with signs or symptoms of AMI or unstable angina is quite different than that used by other specialists who might evaluate such patients in a less critical setting (e.g., a cardiologist seeing a private patient in an office or outpatient clinic environment). The emergency physician's evaluation must be highly focused and follow established principles of emergency medicine (Fig. 2). Although the evaluation and treatment of all patients must be individualized to some degree, increasing experience at high-volume centers nationally indicates that well-constructed institutional strategies, protocols, and critical pathways can help emergency physicians to provide consistent, cost-effective management of such patients.