Q.: When is the 60 y.o. male with sudden onset 9/10 acute crushing epigastric pain and nausea, with a Hx of HTN and high cholesterol not having a classic M.I.?
A.: I don't give a damn, he's still getting the paramedic taxi to the ER stat, and a full cardiac workup until a board-certified ER doc in consultation with another board-certified cardiologist gives him the all-clear. Neither of which would be me and my Portable Ultra-Mini Field Hospital of Wonder.
Which they did, grudgingly, but only some dozens of hours later, after a highly suspicious day of full cardiac evals, and only after admission for acute pancreatitis secondary to a stone-blocked pancreatic duct.
Ain't nobody dying in my lap; your patient, guys. And thanks for the speedy response and great care.
For the record, I much prefer working surrounded by a full ER, rather than merely curious bystanders. But it's nice to know I can still take the act on the road. Especially when the patient relays personal "thanks" several days later, because he still can.