This excellent case comes to us from Paramedic Jack Buckle. Thanks Jack!

You and your partner are in the middle of a busy shift, when you are dispatched to 37 year old male complaining of chest pain.

It's almost 2pm, and a balmy 78 degrees.

You arrive to a well kept house and find your patient sitting in his kitchen. He looks pale, but you don't notice any obvious distress.

"How can we help you today?"

"I just haven't felt well for a couple of days. No energy. Chills. And I've been nauseous."

"What made you call 911 today?"

"Well, to be honest, I started having some chest tightness today and I got really scared."

His discomfort, 6/10, is poorly localized and non-radiating. He describes it as "intermittent". It started when he was at rest, and began about 2 hours prior to calling 911.

After talking with your patient, you understand that he suffers from depression stemming from a rugby accident that left him with a severely painful back condition.

In fact, he has previously undergone L5-S1 fusion surgery. He takes several pain meds for this chronic condition.

Although he states that during a recent hospital stay (related to back pain) he had to be on the cardiac monitor (he doesn't know why), he denies any history of cardiac problems, and no allergies.

Vitals:

Pulse: 78 regular

BP: 141/90

RR: 20, unlabored

SpO2: 99% on high flow O2

Skin: pale, cool and dry

You acquire the following 12 lead ECG:

You are 14 minutes from the community hospital, and 22 minutes from the nearest PCI center.

YOU MAKE THE CALL:

What do you think is going on with this guy?

Where should you take him?

How should you treat him?