EMS is called to the scene of a 58 year old male complaining of chest pain.
On arrival, the patient is found tripoding in a chair. He is pale, diaphoretic, and appears acutely ill. He is anxious but alert and oriented to person, place, time and event.
Onset: Pain started after carrying luggage up stairs.
Provoke: Nothing makes the pain better or worse.
Quality: Pain is described as "burning".
Radiate: Pain is across the center of his chest and poorly localized. Patient denies radiation of the pain but complains that the BP cuff is hurting his right arm, even when it's not inflated.
Time: About 15 minutes prior to EMS arrival.
He admits to mild dyspnea. He admits to nausea but has not vomited. No JVD sitting upright. No pedal edema.
SpO2: 95 on RA
Breath sounds: clear
Past medical history: dyslipidemia
The cardiac monitor is attached.
A 12 lead ECG is captured.
Due to equipment and/or network problems, the ECG is not able to be transmitted to the Lifenet Receiving Station for physician evaluation (a common occurrence these days). Update: No longer much of a problem with the new web-based LIFENET.
What is your impression?
How would you treat this patient?