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Cardiac Madness

I want you to jump into a scenario with me. You and your partner are requested to transfer a STEMI from a small community hospital to a large PCI-capable facility approximately 1 hour away. Driving to the transfer, the conversation remains relatively benign, not expecting many dynamic decisions to be associated with a “simple STEMI”.

You walk into the facility with your partner. Greeted by the sending PA, they give you a brief report.

“This is Billy; he’s 58 years old. He began with chest discomfort, nausea, and diaphoresis while shoving his driveway. He came into the ED looking quite unwell with hypotension. His ECG shows an inferior wall MI, and he is being transferred for PCI. He has a history of HOCM; as a result, we will start him on phenylephrine.”

Apparent confusion comes across your face, wondering why you are initiating a patient on a purely alpha-based vasopressor. You become concerned with inc