Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of substernal chest pressure, radiating to the jaw and epigastrium, associated with diaphoresis, nausea, and lightheadedness. Symptoms began [Time] ago, described as [Quality: crushing/squeezing] and rated [Scale: 1-10] in severity. No prior history of similar symptoms. ECG confirms ST-segment elevation in leads II, III, and aVF, consistent with acute inferior wall myocardial infarction involving a dominant RCA.
Clinical Examination Findings
General: Patient appears distressed, diaphoretic, and pale. Vitals: Tachycardic/Bradycardic, Hypotensive/Hypertensive, O2 sat [Value]%. Cardiovascular: S1/S2 present, no murmurs, rubs, or gallops. JVD noted. Lungs: Clear to auscultation bilaterally or bibasilar crackles present. Extremities: Cool, clammy, no peripheral edema. Neurological: Alert and oriented x3, no focal deficits.
Treatment Protocol
Immediate management initiated: Aspirin 325mg chewed, P2Y12 inhibitor (Ticagrelor/Clopidogrel) administered. IV access secured; Heparin bolus/infusion started. Morphine/Nitroglycerin administered for pain management per protocol. Patient prepared for emergent cardiac catheterization and primary PCI of the RCA. Monitoring for bradyarrhythmias or AV blocks secondary to RCA occlusion.