Use this case study as an educational tool by answering the questions posed by the author, then reviewing the answers further down.
At 6:45 a.m., your unit is dispatched for a 50-year-old male with chest pain. You and your partner proceed to the scene, with a response time of approximately eight minutes. The closest hospital from the scene is 40 miles away.
You arrive at the scene, don appropriate BSI precautions and ensure that the area is safe, then knock on the door of the patient's residence. A middle-aged male answers the door and identifies himself as the patient. You note that he is diaphoretic and anxious, and is clenching his fist against the center of his chest.
1. What is the significance of the patients clenched fist in the center of his chest?
You sit the patient down and perform an initial assessment (Table I). Your partner attaches a pulse oximeter and prepares to administer oxygen to the patient.
Your partner administers 100% oxygen to the patient with a nonrebreathing mask while you perform a focused history and physical examination (Table II). The patient tells you that his doctor prescribed nitroglycerin for him; however, because he recently moved into the house, he thinks it's still packed in one of the boxes.
Table I: Initial Assessment
Level of consciousness: Conscious and alert to person, place and time; restless and anxious.
Table II: Focused History and Physical Examination
Onset: "This began suddenly. It woke me from my sleep."
2. What are the physiologic effects of nitroglycerin?
After confirming no history of bleeding disorders or allergies, you administer 324 mg of aspirin to the patient. Your partner obtains baseline vital signs and a SAMPLE history (Table III). The patient remains conscious and alert, but is becoming increasingly restless. You attach the patient to a cardiac monitor and interpret his cardiac rhythm as sinus tachycardia at 110 beats per minute.
After administering 0.4 mg of nitroglycerin sublingually to the patient, you and your partner attach the remaining ECG leads and obtain a 12-lead tracing of the patient's cardiac rhythm. As your partner stands up to retrieve the stretcher from the ambulance, you tell him that it looks as though the patient may be having an anterior wall MI.
Table III: Baseline Vital Signs and SAMPLE History
Blood pressure: 160/92 mmHg.