EMS is called to the residence of a 69 year old male complaining of chest pain.
On arrival the patient is found sitting in a kitchen chair.
He appears acutely ill.
Skin is ashen, cool, and very diaphoretic.
Levine's sign is present.
It is obvious that the patient is anxious and in severe pain.
Onset: Sudden onset approx 20 minutes before EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: Severe pressure
Radiate: The pain does not radiate
Severity: 10/10
Time: No previous episodes
Breath sounds are clear bilaterally.
Vital signs are assessed.
RR: 20
Pulse: 60 R
BP: 142/68
SpO2: 90 on RA (increases to 96 with oxygen via NRB @ 15 LPM)
BGL: 104
No known drug allergies.
Denies any significant medical history other than "indigestion".
The cardiac monitor is attached.
A 12-lead ECG is captured.
Another 12-lead ECG is captured with modified chest leads V4R, V5R and V6R.
How would you treat this patient?
Is there anything about this case that surprises you?
