A man in his 30s with chest pain. How was he managed? What if they had used the Queen of Hearts?

Written by Pendell MeyersA man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity. He stated it did not feel like his prior episodes of reflux. Vitals were within normal limits except some hypertension. Triage ECG:And here she explains her assessment:The ECG was read as simply " No ST elevation. " Which is true.The initial high sensitivity troponin I returned at around 3300 ng/L. No repeat ECG was done at this time.CT pulmonary angiogram (unnecessary, often done while missing OMI) was unremarkable.The diagnosis of " NSTEMI " was made. The physician initiated routine transfer to the local PCI center. Cardiology refused to be the admitting physician because it was " NSTEMI " , and forced the ED physician to admit the patient to the hospitalist. Of course, there was terrible boarding and the patient was considered non-emergent (NSTEMI), and so could not leave the ED for some time. Watch what happens in real life to NSTEMIs with refractory chest pain:" During ED course patient received 2 sublingual nitro with no improvement in his pain. I discuss this with cardiology who requested treating his hypertension with metoprolol 25 mg PO which mildly improved his pressure to 130 systolic. Patient received 4mg morphine which improved symptoms to ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs