A 58-year-old man presents to the emergency department with acute-onset, crushing substernal chest pain radiating to his left jaw that began 45 minutes ago. He is diaphoretic and appears distressed. Vital signs show a blood pressure of 145/90 mm Hg and a heart rate of 92/min. Arrange the following steps in the most appropriate chronological order for the initial diagnosis and definitive management of this patient's condition.
- 1Perform and interpret a rapid 12-lead electrocardiogram (ECG)
- 2Administer chewable aspirin and a P2Y12 receptor inhibitor
- 3Transfer the patient urgently to the cardiac catheterization laboratory
- 4Perform primary percutaneous coronary intervention (PCI)
Answer
The correct sequence is: 1) Perform a 12-lead ECG, 2) administer dual antiplatelet therapy, 3) transfer to the catheterization lab, and 4) perform primary PCI.
In a patient presenting with classic symptoms of acute coronary syndrome, the immediate priority is to perform a 12-lead ECG to differentiate between a STEMI and other causes of chest pain. Once a STEMI is diagnosed, early pharmacological intervention with chewable aspirin and a P2Y12 inhibitor is indicated. Following this, the patient should be rapidly transferred to the cardiac catheterization laboratory where primary percutaneous coronary intervention (PCI) is performed to definitively restore coronary perfusion.
Step-by-Step Solution
Key Concept
The timely diagnosis and sequential management of ST-elevation myocardial infarction (STEMI).