Chest pain and a rising troponin

A 54-year-old presents at 3am with pain that woke him, and the first troponin is only slightly up.

54-year-old manED, resus 2Fictitious educational patient

Type 2 diabetesSmokerFamily history of early coronary disease

Day 0 · 03:10

Arrival

Central heaviness for ninety minutes, radiating to the left arm and jaw, with sweating and nausea. It woke him from sleep. He has taken his own aspirin at home. He looks grey.

Vitals

HR96BP148/88RR20SpO296%T36.8

What is the first thing that must happen, before anything else?

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