It seems like this pt is having some sort of GI bleed, of which is causing him to be anemic. This would cause his shortness of breath, as well as St segment elevations, even precipitating an MI. He is on coumadin, he is not tachy probably because of his B blockers, an his urine is dark. Would not be inclined to think that the dark urine is myoglobin, (nothing in hx to point to that). His pressure is up, most likely because he is compensating, although, his pulse pressure might be narrowing. This could be because of cardiac disease, or blood loss. One would keep an eye on his pulse pressure enroute. I would placed two lines, and give high flow 02. I would probably hold the ASA on this one, but would confer with med command just to make sure. Hope this helps.