joann smith is a 68-year-old woman who presents to the emergency department (ed) after having three days of progressive weakness. she denies chest pain, but admits to shortness of breath (sob) that increases with activity. she also has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. she reports that her epigastric pain has gotten worse and is now radiating into her neck. her husband called 9-1-1 and she was transported to the hospital by emergency medical services (ems)