Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute substernal chest pressure radiating to the left jaw, associated with diaphoresis and nausea. ECG demonstrates ST-segment elevation in leads V3-V4 with reciprocal changes in inferior leads, consistent with distal LAD occlusion. Onset of symptoms occurred [Time] ago. Pain score [0-10]. No prior history of thrombolytic contraindications.
Clinical Examination Findings
Patient appears in acute distress, diaphoretic and pale. Cardiovascular: Tachycardic, regular rhythm, S1/S2 present, no murmurs, rubs, or gallops. Pulmonary: Clear to auscultation bilaterally, no rales or wheezing. Extremities: No peripheral edema, pulses 2+ bilaterally. Neurological: Alert and oriented x3, no focal deficits.
Treatment Protocol
Immediate administration of Aspirin 325mg (chewed) and P2Y12 inhibitor (loading dose). Initiated IV Heparin bolus per ACS protocol. Patient transferred emergently to Cardiac Catheterization Lab for primary PCI of distal LAD. Oxygen titrated to maintain SpO2 >94%. Nitroglycerin administered for pain control, titrated to systolic BP >90 mmHg.