At approximately 1530 hours, Rescue 24 responds to a person complaining of chest pain. Upon arrival, the crew performs an initial assessment. It reveals a patient in moderate distress, diaphoretic and with cool skin, but alert, oriented and cooperative. The patient, an overweight 64-year-old male, informs the crew that he was watching television when he began to experience epigastric discomfort and became nauseous.

The crew completes a head-to-toe assessment, obtains vital signs (BP 88/50, pulse 94, respiratory rate 18), administers 100% oxygen via a non-rebreather mask, applies an ECG monitor and performs a 12-lead ECG, attaches an SaO2 monitor, assesses blood glucose (125 mg/dL) and initiates two intravenous lines of normal saline. They administer a 500cc fluid bolus and note improvement in the patient’s blood pressure to 142/86 mmHg.

What would you do next ?

Upon arrival at the emergency department, the patient experiences a generalized seizure and goes into cardiac arrest-the ECG monitor displays ventricular fibrillation.

Now what?

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