A 45-year-old man is alert and oriented, complaining of chest pain. He describes a two-day history of worsening pain, described as a burning sensation below his left breast that radiates across his chest. He states that the pain seems to get better right after eating, but then worsens again. Medical history includes myocardial infarction, hypertension, and type 2 diabetes. His medications include Inderal, Vasotech, Glucotrol, and Lopid. Physical examination reveals cool, dry skin; clear lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86, RR = 12, SaO₂ = 98%. The patient is on oxygen by nasal cannula at 4 liters per minute. Which of the following should be done next? A) Give 81 mg aspirin by mouth. B) Start precautionary IV of normal saline and transport. C) Give 0.4 mg nitroglycerin sublingually. D) Do a 12-lead ECG.

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Quizplus · Accepted Answer

The patient's presentation is consistent with possible angina or myocardial infarction, given his history and symptoms. Therefore, obtaining a 12-lead ECG is crucial in assessing for cardiac ischemia or infarction, and can guide further treatment and disposition. Aspirin is also a standard treatment for suspected acute coronary syndrome, but this should be done after obtaining the ECG. Starting an IV and giving nitroglycerin may be indicated after the ECG is obtained and interpreted.

A 45-Year-Old Man Is Alert and Oriented, Complaining of Chest