A patient presents to the ED with 14 hours of chest pain. What is the next step in management?

In the context of a patient presenting to the emergency department with chest pain lasting 14 hours, the priority is to assess for potential acute coronary syndrome (ACS) or other serious cardiac conditions. If the patient's presentation and clinical indicators suggest a high risk for a myocardial infarction or other cardiological events, immediate action is essential.

Transporting the patient to the catheterization laboratory is appropriate for further evaluation and intervention, especially if there are signs of significant ischemic heart disease. In cases where chest pain is persistent and associated with other risk factors such as abnormal vital signs, elevated cardiac biomarkers, or changes in the electrocardiogram, invasive procedures like coronary angiography can be warranted. This allows for both diagnosis and the possibility of immediate therapeutic interventions such as angioplasty or stenting if significant coronary artery blockages are found.

While administering pain medication may provide symptom relief and is important in managing the patient’s discomfort, it does not address the underlying cause of the chest pain or facilitate definitive treatment. Similarly, while imaging studies such as a chest X-ray or CT scan may provide helpful information regarding other potential causes of chest pain, they are not the immediate priority when a patient presents with concerning signs and symptoms suggesting acute coronary syndrome. These imaging modalities do not directly