[Sdiver]

Haven't done one of these in awhile.

Remember, think the problem through and think outside of the box, or as my ethics professor said, "Instead of thinking outside the box, just expand your box."

Let's go ....


Dispatched on a cardiac emergency, you arrive to a physician's office and are quickly lead to an examination room by office staff.

As you walk into the room you see a male supine on an exam table, profoundly diaphoretic, and lethargic. His skin color is grey and ashen. The doctor meets you at the bedside and shows you this EKG. (see below)

The doctor notes that he knows the patient well, and that he has an extensive cardiac history, and has had two stents placed in his circumflex and RCA within the past year. He walked into the office complaining of chest pain, and then suddenly collapsed about 10 minutes prior to EMS arrival.

The patient is allergic to aspirin (it causes anaphylaxis), and he takes Plavix, Lipitor, Procardia, Vasotec, Glyburide, and isosorbide dinitrate.

He has marked JVD, and ankle edema. His lungs have crackles at the bases, but he is moving air. He responds with a moan to painful stimuli, and has a gag reflex. GCS E2, V3, M4 = 9.

BP 50/30, HR 104, RR 20, SpO2 92% NC 4L, Temp 98.6 F / 37 C
Cap blood glucose = 110.

You are 45 minutes by ground to the nearest PCI (cardiac catheterization) capable center. There is a non-PCI center 15 minutes away by ground. There is a landing zone nearby for a helicopter at the local FD.

What are you next steps in patient stabilization and care, and what would be your transport destination and method? Other thoughts / considerations?