The electrocardiogram (ECG) is one of the primary evaluations performed on patients believed to be suffering from cardiac complications. This is a series of leads connected to the patient that measure the electrical activity of the heart and can be used to detect abnormalities in heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julie's ECG showed ST segment elevation which is the first indication that a myocardial infarction had actually occurred. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acute patient. Therefore the ABCDE framework would be used to evaluate Julie. This means airway, breathing, circulation, disability and elimination. Upon admission, the emergency room staff introduced themselves to Julie and asked her a series of questions about what had happened, which she answered. Since she was able to communicate effectively, this indicates that her airway is clear. Julie appeared extremely pale and short of breath and often complained of a feeling of heaviness radiating from her chest to her left arm. The nurses sat Julie upright to evaluate her breathing. The rate of breathing will vary with age and gender. For a healthy adult, a respiratory rate of 12-18 breaths per minute is considered normal (Blows, 2001). High rates, and especially rising rates, are indicators of disease and a warning that the patient may suddenly worsen. Julie's respiratory rate was recorded to be 21 breaths per minute and regular, which can be described as tachypnea. Julie's chest wall seemed to expand equally and symmetrically on each side with each breath. Julies SP02 levels representing an estimate of oxygen