Question: If a patient presents with both chest pain and sudden onset stroke symptoms, can we still give all medications for cardiac ischemia protocol while doing stroke bypass?

 This would be a very rare scenario. The first thing I would suggest is question your diagnosis. How likely is it that this patient is having ongoing ischemic chest pain AND an acute stroke? If indeed both criteria are met, the second question I would ask would be is it safe to transport a patient with ongoing chest pain possibly beyond the closest emergency department directly to a neurologist who may be uncomfortable managing acute ischemic chest pain? Concomitant chest pain and neuro symptoms should make you consider alternate diagnoses such as aortic dissection. In this case, clearly thrombolysis is NOT indicated.

Bottom line: if you are convinced that the patient is having ongoing active ischemic chest pain, then we would suggest diverting to the closest most appropriate emergency department and not initiating stroke bypass. Highlight to the receiving emergency physician your concern regarding possible stroke candidate and a decision to secondarily transport to a stroke centre can be made at that time if the ED MD feels indicated

Cardiac Ischemia,Cardiac/Circulation

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