ECG of the Week 29th May

The following ECG is from a 64-year-old man who presents with severe abdominal pain. He has been in the waiting room for the past three hours and the emergency buzzer sounds at triage as he has become acutely agitated. 

Interpret his ECG. Outline your immediate management for this patient.

Would you activate a code STEMI?

With thanks to Dr Sani Haxdy for the ECG and the case.