Further Assessment ED
Emergency department physicians mobilized the cardiac cath lab for early primary percutaneous coronary intervention. While awaiting transfer to the cath lab, they carried out further assessment. They confirmed the history and physical examination carried out by the paramedics. They noted a third heart sound at the apex. A stool hemoccult was negative. They confirmed the paramedic's ECG diagnosis of acute anterior infarction and reviewed the patient's prehospital treatment that included aspirin, supplemental oxygen, sublingual nitroglycerin and morphine sulfate.
Electrocardiographic monitoring and pulse oximetry were continued. Her complete blood count, platelets and coagulation studies were normal. The patient's pain was only partially relieved and she was given an additional dose of morphine sulfate. Intravenous heparin, nitroglycerin and beta blocker were also administered. She became more comfortable and her repeat vital signs revealed a blood pressure of 130/95 mmHg in both arms, pulse rate sixty and regular and respirations twenty. She was still diaphoretic and dyspneic.