In suspected acute coronary syndrome with crushing chest pain, which action is appropriate first?

In suspected acute coronary syndrome with crushing chest pain, which action is appropriate first?

• A. Assess the adequacy of his respirations.
• B. Administer up to 324 mg of aspirin.
• C. Obtain vital signs and a SAMPLE history.
• D. Administer up to three doses of nitroglycerin.

Answer: (D)

In suspected acute coronary syndrome, the priority is to relieve the ischemia driving the chest pain as quickly as possible. Nitroglycerin works by dilating blood vessels, which lowers the heart’s workload (preload) and can improve blood flow to the heart muscle. When a patient has a history of nitro use, has a systolic blood pressure high enough to tolerate the drop, and isn’t taking medications that contraindicate nitro, administering up to three doses of nitroglycerin can rapidly alleviate pain and reduce myocardial oxygen demand. This immediate action targets the underlying problem—reduced coronary perfusion—before moving on to other steps like checking vital signs, obtaining history, or giving aspirin. If nitroglycerin is not appropriate (low blood pressure, use of PDE5 inhibitors, or suspected contraindications), the other steps become the focus, but with the scenario as stated, nitroglycerin is the action that directly addresses the cause of the chest pain first. After giving nitro, continue to monitor vital signs, assess breathing, obtain history, and administer aspirin as indicated.

In suspected acute coronary syndrome, the priority is to relieve the ischemia driving the chest pain as quickly as possible. Nitroglycerin works by dilating blood vessels, which lowers the heart’s workload (preload) and can improve blood flow to the heart muscle. When a patient has a history of nitro use, has a systolic blood pressure high enough to tolerate the drop, and isn’t taking medications that contraindicate nitro, administering up to three doses of nitroglycerin can rapidly alleviate pain and reduce myocardial oxygen demand. This immediate action targets the underlying problem—reduced coronary perfusion—before moving on to other steps like checking vital signs, obtaining history, or giving aspirin.

If nitroglycerin is not appropriate (low blood pressure, use of PDE5 inhibitors, or suspected contraindications), the other steps become the focus, but with the scenario as stated, nitroglycerin is the action that directly addresses the cause of the chest pain first. After giving nitro, continue to monitor vital signs, assess breathing, obtain history, and administer aspirin as indicated.