I had a call the other day, 40s female with 7/10 central chest pressure radiating to her left arm, under left breast. PT said that how she felt now is identical to how she felt a few years ago; she had SCAD as in sudden coronary arterial dissection then and had stents put in. How does ASA and nitro play a role in this case, because it sounds textbook ischemic but with such a rare and bizarre medical history. Please let me know what you think?

For the modified valsalva manoeuvre the patient must be normotensive. If we bolus and correct the hypotension are we able to then attempt the manoeuvre?

In the analgesia directive, along with the nausea/vomiting directive is has “unaltered” as a condition. Is this written for the acutely altered patient who has a TBI for example? If we have a patient with a baseline GCS of let’s say 13-14 with dementia who presents with pain and/or N/V but no decrease in baseline mental status, is a patch required, or are they considered unaltered from baseline?

Are we still withholding EPI in bronchoconstriction for greater than 50 year old patients? It’s not in the protocols to but I remember the memo from Feb 2021 saying to withhold it.

When we do a 12-lead and have inferior involvement, the directive states that we assume there is right sided ventricular MI and must confirm with V4R, and then states we should never give nitro for right sided ventricular STEMI. All of that is clear, but what I am wondering is that if the V4R is negative, does that clear the pt for Nitroglycerin use for the inferior STEMI, or does that simply help confirm the STEMI for the emergency department? Thanks.

If the patient has a mint allergy, is Ondansetron contraindicated? On the package for Ondansetron package it says it contains mint.

If a patient is VSA due to a trauma related mechanism, do you still trauma bypass to a LTH (lead trauma hospital).