In an isolated community 500km from the nearest tertiary referral hospital when a 31-year-old Aboriginal man presents to the rural hospital Emergency Department with a three hour history of epigastric pain and vomiting. This is his first presentation to the hospital and you have not seen him as a patient before.
His pulse is 40/min, regular, and blood pressure is 90/40 mmHg. His electrocardiogram shows 4mm ST elevation in leads V1-4 and reciprocal changes inferiorly.
You administer soluble aspirin and intravenous morphine and give an intravenous fluid bolus. There is no change to his pulse or blood pressure with these treatments.
The highest priority for further management is to
• Transfer urgently for percutaneous coronary intervention
• Give a further bolus of 1L intravenous crystalloid fluid
• Commence thrombolysis as per hospital protocol
• Commence an isoprenaline infusion