It is 1000 hours in the emergency department (ed) when the ambulance brings in G.G., a 35-year-old man who is having difficulty breathing

Question

He complains of chest pain and tightness, dizziness, palpitations, nau-sea, paresthesia, and feelings of impending doom and unreality; he is having trouble thinking clearly. He
tells you, "I don't think I'm going to make it. I must be having a heart attack." He is diaphoretic and trem-bling. His vital signs are 184/92, 104, 28, 98.4 ° F (36.9 ° C). this episode began at work during a meeting at
approximately 0920 and became progressively worse. aco-worker called 911 and stayed with him until
medical help arrived. the patient has no history of cardiac problems.

What initial steps would you take and what orders would you expect to receive?

Answer 1

• Stabilize respiratory function. Take oximeter reading on room air; if the Spo
2is low, deliver O
2
by
nasal cannula; titrate upward until Spo
2
is over 90%.
• Stabilize cardiac function. Get an ECG; draw samples for creatinine phosphokinase (CK) and
troponin levels.
• Monitor mental capacity and level of consciousness.
• Draw samples for laboratory tests: CBC; chemistry panel to assess glucose, electrolytes, and
thyroid-stimulating hormone (TSH) to check for thyroid disorder; D-dimer to check for pulmonary
embolism.