Question

A 50-year-old man presents to a small rural emergency department with chest pain suggestive of myocardial infarction. The facility has limited resources and no on-site laboratory. The nearest PCI-capable centre is 3 hours away by road and retrieval is not immediately available due to weather. ECG shows clear ST elevation in V2-V5. What is the most appropriate management strategy?

Accepted Answer

Administer fibrinolytic therapy on-site after basic assessment and monitoring

Answer

Wait until retrieval is available to transfer for primary PCI and withhold treatment

Answer

Discharge the patient with sublingual glyceryl trinitrate and return if pain worsens

Answer

Arrange transfer by private car to the tertiary centre without treatment

Answer

Give only morphine and oxygen and reassess in 6 hours

Practice question