Question

A 50-year-old male arrived at the ED via ambulance after c/o chest pain 8/10 while at work. The medics treated him with? 2 sprays of SL nitro with relief. He is pain free in the ED BP 104/64, HR 88, RR 22, SPO2 94% on RA, T 37.5 PMHX: HTN, High Cholesterol, married with three daughter and two sons, drinks alcohol socially. Father MI 5 years ago, high cholesterol and mother DM: Type 2 and HTN He is placed on the cardiac monitor and a? is obtained. He says” the pain has been on and off for two days, but today it seems the worse”. While he is being assessed he redevelops CP 7/10 and he tells you “ the pain is worst than before”. He is diaphoretic, pale, SOB, and appears anxious. VS are BP 100/40, HR 100, RR 26, SPO2 88% on RA, T 36. He is reconnected to the cardiac monitor and it shows ST Elevation in the inferior leads. A few minutes after complaining of chest pain he suddenly collapses and is pulseless What are the priority nursing interventions? What are the Testing, Diagnostic and Treatment?

Answer 1

This patient should be treated as per cardiac arrest algorithm.

The patient had angina that was relieved by rest. In arrival he had pain which was relieved by sublingual nitroglycerin.

Following this, he developed sudden cardiac arrest.

The first priority is to attain Return of spontaneous circulation (ROSC).

First and foremost, call for help and then initiate CPR.

See for response and if the patient is unresponsive, start CPR

The chest compressions should be at a rate of 100/min, 5 cm depth, with 30: 2 ratio for compressions and ventillation.

Give continuous CPR and assess for pulse again.

If there is no pulse, give 1mg adrenalin IV stat and continue CPR without delay.

Continue CPR if there is no pulse, intubate and ventillator of necessary and secure wide bore IV access and correct treatable causes.

If ROSC is attained follow post cardiac arrest algorithm. Since the major event tool place on the hospital itself, he is a potential candidate for further cathlab procedures if stable. Otherwise, he need cardiac ICU care till stabilization.

Investigations that should be send include: Troponin, serum electrolytes, CBC, renal function tests and coagulation profile.

If patient is stable coronary angiogram and angioplasty can be considered.