Question

A 68-year-old man presents to a rural emergency department with 90 minutes of crushing central chest pain and diaphoresis. ECG shows ST elevation in leads II, III and aVF. The nearest PCI-capable centre is 4 hours away by ground and 3 hours by air; air transport is grounded by severe weather. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy in the rural emergency department and arrange transfer when feasible

Answer

Immediate transfer by ground ambulance for primary PCI despite 4-hour delay

Answer

Treat with dual antiplatelet therapy only and observe

Answer

Arrange urgent coronary CT angiography before deciding on therapy

Answer

Delay reperfusion until weather improves for safe air transfer to PCI centre

Practice question