A 63-Year-Old Male Is Alert and Oriented, Complaining of Dizziness

Multiple Choice

A 63-year-old male is alert and oriented, complaining of dizziness. He describes an acute onset of dizziness and near-syncope that has lasted for 15 minutes. He is also experiencing substernal chest pain radiating to his jaw, as well as nausea and weakness. Physical examination reveals cool, diaphoretic skin; delayed capillary refill; and mild crackles to the bases bilaterally. He has no significant medical history, but he takes 325 mg of aspirin a day. HR = 220, BP = 88/52, RR = 16, SaO₂ = 92%. Which of the following should be done first?

A) Start an IV of normal saline
B) Synchronized cardioversion
C) Oxygen by nonrebreathing mask
D) Administer 0.4 mg of nitroglycerin sublingually