Crew responded code 4 to possible allergic reaction. PT was a bad historian, who states he has a chest pain post being stung by a wasp. Pt had swelling on the left side of his lower lip where he got stung. PT complains of dizziness/lightheaded. PT had no adventitious sounds in the lungs. PT complained of mild nausea with no vomiting. No incontinence. PT complained of weakness as well. During the assessment, pt complains of chest tightness post the wasp sting, all the answers to CP questions were leading the crew to believe that patient was experiencing ischemic chest pain. Pt states he has hx of allergic reaction to bee sting. Vitals: 58, sinus bradycardia with LBBB in 12 leads noted. BP: 86/42, RR 22, Sat of 90%. In this case, pt is showing signs of anaphylaxis with multiple symptoms being affected and known allergen exposure, but complaining of ischemic sounding chest pain. Is the crew to be treating with Epi, or should the crew withhold the epi as patient may have ischemic chest pain and it can worsen the cardiac symptoms?

What is considered suspected cardiac ischemia? Is it just the presence of chest pain/ discomfort (heaviness or tightness). Are chest palpitations considered a chest discomfort as well?

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?