Question

A 50-year-old Aboriginal stockman presents to a small remote clinic 2 hours from the nearest hospital with central chest pain for 45 minutes, diaphoresis and an ECG showing 3 mm ST elevation in leads II, III and aVF. Fibrinolysis is available on site; transfer to PCI-capable centre will take at least 3 hours. According to rural ACS principles, what is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolysis as soon as possible, then arrange transfer (pharmaco-invasive strategy)

Answer

Arrange immediate transfer for primary PCI without fibrinolysis

Answer

Give oxygen and analgesia only and observe

Answer

Wait for pain resolution before deciding

Answer

Start heparin only and transfer by road without reperfusion

Practice question