CAD / dispatch — incoming

Chest pain & suspected STEMI — prehospital reperfusion decisions

Review the assignment, then acknowledge dispatch to go en route to the scene.

Assignment text

14:22 — residential driveway, suburban response. 58 y/o male, caller states "crushing chest pain," conscious, breathing, cold sweats. ALS engine 2 + medic unit 4, ETA 4 minutes.

Response location: Single-family home, driveway shoveled. Patient seated on garage step, tripod position, clutching chest. Indoor temperature cool; patient only in a flannel shirt. Family anxious; spouse reports he "never complains."

Faculty orientation (optional)

STEMI care is a supply-chain problem: ECG → recognition → activation → transport → reperfusion. Hypotension + inferior ST changes should trigger RV infarct caution with NTG. Door-to-balloon is a system metric; your levers are first contact-to-ECG and cath lab prealert. VF in ACS is treated as VF — unsynchronized shock.

Case framing

58 y/o with crushing substernal chest pain radiating to the jaw and left arm, diaphoretic, pale. Onset ≈40 minutes ago while shoveling snow. You are the paramedic team lead on an ALS ambulance in a PCI-capable region. This scenario stresses time-sensitive STEMI recognition, contraindicated therapies, cath lab activation, transport triage, and a high-acuity complication. Educational only — not protocol for your jurisdiction.