This was in the back of an ambulance. Pt stated that he felt the same “crushing” pain he felt 5 years ago, radiating down his left arm. Every minute or so he would jolt in pain and then relax and speak normally. Cool, pale, diaphoretic. Also, chronic EToH abuse. BP was 168/110. 3 lead showed ST elevations in lead II so I immediately went for a 12-lead. Massive ST elevations in v2, v3, v4, and v5 with pathologic q-waves. Anteroseptal as well as ischemia in leads 2 and aVF. Non-compliant with meds, hx of MI and HTN. I go to give him a nitroglycerin spray to relieve the pain and dilate the coronary arteries a bit and when I turn around, pt is starting to go into arrest which looks like the beginning of a tonic seizure. Pads applied but eyes still have sympathetic movement. No pulse, apneic, and obviously unresponsive at this point. Epi was being drawn up by my partner. After confirmation of no pulse, no signs of life I initiated CPR and eyes become fixated. Shock is then immediately delivered. CPR resumed. Suction of vomitus and secretions as I go for an intubation attempt. As I was about to pass through the glottic opening, pt starts gagging so I withdraw and resume BVM upon inspiration with visible vapor upon pt’s exhalations. As breaths increase in quality and is appropriately spontaneous, I aid in giving high-concentration O2 every couple of breaths only. Pt is confused and lethargic but responsive to painful stimuli and making sounds. Put on NRB. Once he was satting at 99-100% and becoming more lucid, I removed the NRB and he was satting at 100 on RA, satisfying me, I didn’t want to hyperoxygenate. At this point he realized where he was and started speaking. And I said “welcome back, sorry about your rib 😬.”