Medical Emergencies · patient case question
What is your immediate management?
Patient case: Chest pain in a patient with reflux and cardiac history
Patient: Adult with multiple medical problems
Chief complaint: Substernal pain radiating to the shoulder, beginning in the chair.
Background: Gastro-oesophageal reflux disease on medication. Hypertension. Known cardiac history and dyspepsia.
Vital signs / labs: Vital signs normal. No arrhythmia detected.
Current findings: Pain is substernal and radiates to the shoulder.
Show answer and explanation
Correct answer: B. Stop treatment, position him comfortably, give oxygen and administer his nitroglycerin
- A. Continuing any treatment during an episode of possible cardiac ischaemia is indefensible.
- B. CORRECT. Stop, position the patient upright or semi-upright for comfort, give oxygen, and administer sublingual nitroglycerin, monitoring vital signs. If the pain does not resolve after three doses at five-minute intervals, treat it as a myocardial infarction: activate emergency services and give aspirin to chew, unless contraindicated.
- C. Glucose is the treatment for hypoglycaemia, which does not present in this way.
- D. Trendelenburg is used for syncope. In cardiac chest pain it increases venous return and cardiac workload, and worsens breathlessness.
Note: Sequence worth memorising: stop, position, oxygen, nitroglycerin. If unresolved after 3 doses over 15 minutes, treat as myocardial infarction — call emergency services and give aspirin to chew.
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