Briefly without pulse, has pulmonary edema and LBBB with 10 mm of ST Elevation

A middle-aged male was found down.  EMS was able to get the patient to climb onto the ambulance by himself, then during transport he became less responsive.  They briefly could not find pulses, and gave a short period of CPR with ROSC, but he did not require a shock. They gave Narcan without improvement.  An oral airway was placed and BVM oxygenation provided.  The patient arrived unable to provide any further history.BP was 180/100, HR 130, Oxygen saturations 84%.He was intubated.  A bedside ultrasound showed poor global function and B-lines of pulmonary edema.Here was the first ECG:There is sinus tach and left bundle branch block (LBBB).There is massive ST Elevation in V2 and V3The ST segment in V3, as I measure it, is 10 mm, with a 38 mm S-wave.The ratio is 10/38, which is greater than 0.25, consistent with LAD occlusion.This meets the modified Sgarbossa criteria, which have been derived and validated.Should we diagnose anterior STEMI?Should we activate the cath lab?Here is the chest x-ray, in case you don't believe in B-lines:Profound Pulmonary EdemaRemember:In both of the studies of the Modified Sgarbossa criteria, we excluded patients with extremely elevated BP, pulmonary edema, extreme tachycardia, or hyperkalemia.That is because these patients need supportive care and then, subsequently, a decision on the cath lab.This patient would have been excluded from the studies.The blood gas returned with severe acidemia, with both metabolic and respira...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs