50 years old gentleman with no comorbid present with presyncopal attack. He is active smoker.
Complaint of sudden presyncopal at 7pm while went to toilet.
Denies chest pain.
At the same time he feel very weak, dizzy, shortness of breath, diaphoresis then later fall and sustained right knee soft tissue injury.
Upon arrival BP was 98/67 mmHg.
Fig 1. ECG Upon arrival
After looking at ECG, you administer T. Aspirin 300mg STAT, T. Plavix 300mg STAT and S/C Arictra 2.5mg STAT.
Fig 2. 15 minutes later
Fig 3. 30 minutes later
Patient remain comfortable and chest pain free despite dynamic ECG Changes.
BP remain stable at 120-110 systolic and 80-60 diastolic and no tachycardia.
What should you do?