You and your partner are called emergently to a private residence for a 50yom experiencing chest discomfort and shortness of breath. The patient is seated on his front steps, stating that the pain started shortly after mowing his lawn approximately 45 minutes ago. The pain is dull and mid-sternal; the patient also has gerd, and states that he went inside and took “an Alka-seltzer” with no relief. His skin is flush, moist, and warm.
- Nicotine patches
- BP: 168/104
- RR: 28bpm
- Unlabored but tachypneic
- Lung sounds are clear and equal bilaterally
- Patient able to speak in complete sentences between breath
- Equal rise and fall
- HR: 76/equal with a bounding pulse
- SpO2: 96% on R/A
- BGL: 139mg/dl
- 324.0mg ASA
- O2 @ 2lpm via cannula
- Large bore IV start with lab draw
- 0.4mg SL Nitro with no pain improvement
- 100.0mcg Fentanyl IV with no pain improvement
- 4.0mg Zofran IV with improved nausea
- Crew called a STEMI activate from the field
- Emergent transport to PCI Center
- No change in vital signs or mentation en route
- 100% LAD occlusion
- PCI performed with full recovery
- Possibility of digression into VF with lateral AMI
- Use of routine O2 in STEMI
- Zofran use during active ischemia
- Proactive defibrillator pad placement during AMI?
- Good idea?
- Bad idea?