What should be done immediately upon arrival in the ED for a patient with suspected myocardial infarction?

Upon arrival in the emergency department for a patient with suspected myocardial infarction, obtaining a 12-lead ECG is crucial as it is a primary diagnostic tool to assess the presence and extent of cardiac ischemia or infarction. This test allows for immediate visualization of the electrical activity of the heart, helping to identify ST-segment elevations or depressions, which are key indicators of a myocardial infarction. Rapid identification of these changes can significantly impact clinical management, including the decision to initiate reperfusion therapies such as thrombolysis or percutaneous coronary intervention.

While administering aspirin is important for its antiplatelet effect in managing acute coronary syndrome, it usually follows the rapid assessment of the patient's cardiac status. Starting intravenous fluids and performing a physical exam are also necessary components of patient care but are not as critical for immediate diagnosis or intervention in the context of a suspected myocardial infarction. Therefore, prioritizing the ECG allows for timely diagnosis, which is essential for improving patient outcomes.