Introduction Patients presenting with chest pain, along with other symptoms suggestive of acute coronary syndromes, are increasing by the day, not only in Australia but also globally (Cullen, 2010). Indeed, according to Vermeer & Bajorek (2008), acute coronary syndromes (ACS) are increasingly becoming a major health challenge in Australia, accounting for about 25,000 mortalities and 156,000 infirmary admissions annually. Yet, not all patients presenting with chest pains have a final diagnosis for ACS, with statistics indicating between 75% and 85% of patients evaluated in Australia ultimately do not exhibit a final diagnosis of ACS (Cullen, 2010). These statistics provide compelling evidence on the need for health institutions to develop guidelines aimed at identifying patients at risk of ACS, and, more importantly, the need to continuously update them with current evidence-based knowledge to assist clinicians select the best management strategies for a typical presentation (Kumar & Cannon, 2009). This paper aims to provide a critique to the chest pain management guidelines in use in acute clinical settings at my current hospital. In particular, the critique will first review relevant literature to explore whether existing guidelines are based on the latest literature, then rationalize how the guidelines need to be reformulated, based on current literature, to respond to presenting demands with regard to rapid risk assessment for ST-elevation acute coronary syndrome and the therapeutic management of chest pain caused by ACS. Brief Overview of the Policy This particular policy, last reviewed in 2010 and expected to be reviewed again in 2013, concerns itself with how to assess patients presenting with ischemic chest pain in acute ward settings, and the therapeutic management of the condition depending on severity or intensity. As is the case with other policies aimed at undertaking risk assessment for ACS, this policy comes with a flow chart demonstrating the steps to be followed in the therapeutic management of ischemic chest pain, the protocols of managing this type of pain, and a set of guidelines to ensure successful risk assessment and management of ischemic chest pain. The presented flow chart, along with the prescribed guidelines and modalities of therapeutic management, will be critiqued against current literature in the rationalization section of this paper. Review of Current Literature Vermeer & Bajorek (2008) observe that “…ACS encompasses a number of cardiovascular presentations which differ by the extent and duration of coronary occlusion, and include unstable angina, non-STEMI, and STEMI” (p. 591). The Scottish Intercollegiate Guidelines Network (SIGN) notes that all these conditions projects “…a common aetiology in the formation of thrombus on an inflamed and complicated atheromatous plaque” (SIGN, 2007, p. 1). A systematic review of three articles (Siebens et al, 2007; Aroney et al, 2008; Marshall, 2011) demonstrated that the clinical presentation of ACS is most often acute chest pain and/or discomfort. Ryan & Reeder (2011) note that the primary objective of chest pain management guidelines in any hospital setting, therefore, is to aid in precisely determining the cause of the chest discomfort an