Tell me about it.... Ii was Streaming Nurse in our department yesterday and saw a 59-year-old lady with chest pain. As she walked in, I could see she was rather pale and after she'd given me no more than 60 seconds worth of her history I was walking her through to Resus. She'd gone to her GP that morning with a history of palpitations from about 2300 previous night and chest pain that had woken her from sleep. Her GP 'referral' letter noted the history along with tachycardia (140 bpm!!), irregular pulse and pallor - yet instead of giving aspirin, nitrates etc he 'advised' her to drive herself to A&E!!! Her 12-lead showed a new fast AF with global ischaemia and she eventually went to CCU. Now I've only been qualified for 4 years and in A&E for 3 but I could see the combination of chest pain/looks like crap/feels sick = Resus/oxygen/nitrates/aspirin a.s.a.p - why couldn't he?