A patient with chest pain who has not taken nitroglycerin yet: after administering supplemental oxygen if needed and contacting medical control, which action is appropriate?

A patient with chest pain who has not taken nitroglycerin yet: after administering supplemental oxygen if needed and contacting medical control, which action is appropriate?

• A. Begin immediate transport and request a rendezvous with a paramedic unit.
• B. Assist him with his nitroglycerin unless his systolic blood pressure is less than 100 mm Hg.
• C. Administer the nitroglycerin unless he has taken Viagra within the past 72 hours.
• D. Administer up to three doses of nitroglycerin before assessing his blood pressure.

Answer: (B)

In this scenario the key idea is giving nitroglycerin safely to relieve ischemic chest pain. Nitro can help by dilating vessels and reducing the heart’s workload, but it can also cause a significant drop in blood pressure. After confirming oxygen and obtaining medical control, the correct action is to assist the patient with his nitroglycerin if his systolic blood pressure is at least 100 mm Hg. This threshold provides a safety margin so that vasodilation won’t lead to dangerous hypotension. If the systolic BP is below 100, nitroglycerin should be withheld and the patient reassessed. Other options don’t fit because they either delay therapy (begin transport before addressing blood pressure and nitro) or ignore the need to verify blood pressure before each dose, or rely on a single contraindication (like Viagra) without considering the blood pressure requirement.

In this scenario the key idea is giving nitroglycerin safely to relieve ischemic chest pain. Nitro can help by dilating vessels and reducing the heart’s workload, but it can also cause a significant drop in blood pressure. After confirming oxygen and obtaining medical control, the correct action is to assist the patient with his nitroglycerin if his systolic blood pressure is at least 100 mm Hg. This threshold provides a safety margin so that vasodilation won’t lead to dangerous hypotension. If the systolic BP is below 100, nitroglycerin should be withheld and the patient reassessed.

Other options don’t fit because they either delay therapy (begin transport before addressing blood pressure and nitro) or ignore the need to verify blood pressure before each dose, or rely on a single contraindication (like Viagra) without considering the blood pressure requirement.