You Are Dispatched to a 40-Year-Old Male Complaining of Chest

You are dispatched to a 40-year-old male complaining of chest pain. On arrival at the residence you are met at the door by the patient, who appears distressed and in pain and is sweaty. After seating the patient he tells you that he experienced the onset of a heavy central chest pain radiating down his left arm about 30 minutes after using cocaine. He describes associated shortness of breath, palpitations and sweating. He states that he uses cocaine once or twice a week and has done for the past 5 years. He denies any other alcohol or drug use, any significant past medical history, current medications or allergies. His vital signs are:
A. Heart rate: 124 irregular Blood pressure: 145/90 Skin: pale, warm, sweaty Resp rate: 20 non-retractive SpO2: 98% room air
B. Temp: 37.2°C (tymp)
C. ECG: Sinus tachycardia with occasional PVSs; ST segment elevation in leads 1, aVL,V3,V4,V5 and V6
The most appropriate management of the patient in question 8 above is:

A) Management of his STEMI with aspirin, glyceryl trinitrate, narcotic analgesia and institution of an appropriate re-perfusion strategy such a pPCI or thrombolysis
B) Manage the patient with an intravenous benzodiazepine such as midazolam as his symptoms are most likely due to the effects of cocaine and will resolve once his tachycardia and hypertension are managed
C) Manage his STEMI with glyceryl trinitrate, narcotic analgesia and transport to a hospital capable of performing pPCI. Aspirin and other antiplatelets, anticoagulants and fibrinolytic agents are contra-indicated due to the increased risk of intracerebral haemorrhage in this patient
D) Manage with glyceryl trinitrate only as the ST segment elevation is most likely due to spasm of the coronary arteries secondary to cocaine use and this will most likely resolve the spasm