In this conversation, the Alert Medic 1 team is joined by the Okayest Medic Podcast host to discuss the 2025 guidelines for managing patients with acute coronary syndromes (ACS). They emphasize the importance of understanding clinical practice guidelines, the levels of evidence behind recommendations, and the critical role of patient history and assessment in emergency medical services (EMS). The discussion covers the significance of serial EKGs in detecting dynamic changes in cardiac patients, the appropriate use of oxygen therapy, and strategies for managing high-risk patients. The team highlights the need for effective communication with receiving hospitals and the importance of continuous education in improving patient care. In this conversation, the speakers delve into critical aspects of emergency cardiac care, focusing on the use of epinephrine in life-threatening situations, the significance of troponin levels in diagnosing myocardial infarctions, and the importance of posterior EKGs in identifying STEMIs. They also discuss pain management strategies, particularly the use of nitroglycerin versus fentanyl, and emphasize the need for clinical judgment in assessing chest pain. The discussion culminates in a series of insights and recommendations for emergency medical professionals.