A 63-year-old male is alert and oriented, complaining of dizziness. He describes an acute onset of dizziness and near-syncope that has lasted for 15 minutes. He is also experiencing substernal chest pain radiating to his jaw, as well as nausea and weakness. Physical examination reveals cool, diaphoretic skin; delayed capillary refill; and mild crackles to the bases bilaterally. He has no significant medical history, but he takes 325 mg of aspirin a day. HR = 220, BP = 88/52, RR = 16, SaO₂ = 92%. Which of the following should be done first?

Question

Quizplus · Accepted Answer

The patient is presenting with symptoms consistent with an acute coronary syndrome, and oxygen should be administered first to improve oxygenation and reduce cardiac workload. Starting an IV and administering nitroglycerin should also be done relatively quickly, but oxygen takes priority. Synchronized cardioversion would not be appropriate in this situation as the patient is not in a shockable rhythm.

A 63-Year-Old Male Is Alert and Oriented, Complaining of Dizziness