Question

You are responding to a 72yo male with a chief complaint of chest pain. As you arrive on scene you find a 72yo m sitting upright in a chair and clutching his chest that appears to be in pain. The patient denies any shortness of breath. The patient has NKDA and a PMHx of an MI 5 years ago and is currently taking medications to control cholesterol. The patient denies taking any ED drugs in the past 24 hours.

Vital Signs: BP: 160/82 SPO2: 91% on RA HR: 98 FSBS: 76 RR: 17
Skin: Pale/ Cool/ Diaphoretic


What are 2 differential diagnoses for this patient?



What medications can you administer?




What are the dosages of these medications and why are you administering them?




What is the role of oxygen in someone who may be experiencing a MI?

Answer 1

The two differential diagnoses for this patient are:

* **Myocardial infarction (MI)**. This is a heart attack, which is caused by a blockage in one of the coronary arteries.

* **Acute coronary syndrome (ACS)**. This is a group of conditions that can lead to a heart attack, including unstable angina and non-ST-elevation MI.

The patient's vital signs are consistent with both MI and ACS. His blood pressure is elevated, his heart rate is increased, and his oxygen saturation is decreased. He is also pale, cool, and diaphoretic. These are all signs of decreased blood flow to the heart.

The patient's history is also consistent with MI or ACS. He has a history of MI, and he is currently taking medications to control cholesterol. This suggests that he has underlying coronary artery disease, which is a risk factor for MI and ACS.

The medications that can be administered to this patient include:

* **Aspirin**. This is a blood thinner that can help to prevent the formation of blood clots, which can block coronary arteries and cause a heart attack.

* **Nitroglycerin**. This is a medication that can dilate coronary arteries and improve blood flow to the heart.

* **Oxygen**. This can help to improve oxygen delivery to the heart.

The dosages of these medications and the reasons for administering them are as follows:

* **Aspirin**. The standard dose of aspirin for a heart attack is 325 mg. This can be given orally or crushed and dissolved under the tongue.

* **Nitroglycerin**. The standard dose of nitroglycerin for a heart attack is 0.4 mg sublingually. This can be repeated every 5 minutes for up to 3 doses.

* **Oxygen**. The goal oxygen saturation for a heart attack is 95% or greater. If the patient's oxygen saturation is below 95%, they should be given oxygen by nasal cannula or mask.

The role of oxygen in someone who may be experiencing a MI is to improve oxygen delivery to the heart. This can help to reduce the amount of damage that is caused by the heart attack.

In addition to these medications, the patient should also be monitored closely for signs of further complications, such as arrhythmias or heart failure. They should also be transported to the hospital for further evaluation and treatment.