Cardiogenic shock and thromobolysis (with some more challenges thrown in)

It is mid afternoon in your busy regional ED when the triage nurse calls for help. A 57 year old woman who drove herself to hospital managed to tell her that she has been having awful pain in her chest when she collapsed, collecting her forehead on the windowsill on the way down. You poke your head through the triage window to see her looking up at you from the floor, clearly not well.

By the time you unstick your head from the triage window the patient has been moved onto a gurney. She is awake but with a clouded conscious state (confused mumbling, eyes open but not fixing and focusing, localising to pain) and his vitals are HR 40, BP 60/-, RR 26 with end of the bed wheeze, SpO2 not readable, afebrile. She is bathed in sweat and pale.

This is her 12 lead ECG


What to do? Read on and see what you think.

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