A 58-year-old man presents to the emergency department complaining of sudden-onset, severe, crushing substernal chest pain that began 45 minutes ago and radiates to his left jaw. His blood pressure is 140/90 mmHg, heart rate is 92/min, respiratory rate is 16/min, and oxygen saturation is 98% on room air. Physical examination reveals an anxious, diaphoretic patient with normal heart sounds and clear lungs. Arrange the following initial management steps in the most appropriate chronological sequence for this patient.
- 1Obtain a 12-lead electrocardiogram (ECG)
- 2Administer chewable aspirin
- 3Activate the cardiac catheterization laboratory
- 4Perform primary percutaneous coronary intervention (PCI)
Answer
The correct sequence begins with diagnostic confirmation via an ECG, followed by initial medical stabilization with aspirin, activation of the appropriate specialized resources, and culminates in definitive mechanical reperfusion via PCI.
The standard of care for a patient presenting with classic symptoms of acute coronary syndrome is to establish a diagnosis immediately with a 12-lead ECG (goal < 10 minutes). Once a suspected ischemic event is identified, aspirin is given to halt thrombus progression. If the ECG demonstrates a STEMI, the catheterization lab must be alerted immediately so they can prepare for the definitive treatment, which is mechanical revascularization (primary PCI).
Step-by-Step Solution
Key Concept
Initial management protocol for acute ST-elevation myocardial infarction (STEMI)