A 45-Year-Old Man Is Alert and Oriented, Complaining of Chest

Multiple Choice

A 45-year-old man is alert and oriented, complaining of chest pain. He describes a two-day history of worsening pain, described as a burning sensation below his left breast that radiates across his chest. He states that the pain seems to get better right after eating, but then worsens again. Medical history includes myocardial infarction, hypertension, and type 2 diabetes. His medications include Inderal, Vasotech, Glucotrol, and Lopid. Physical examination reveals cool, dry skin; clear lungs; and no JVD or peripheral edema. HR = 102, BP = 132/86, RR = 12, SaO₂ = 98%. The patient is on oxygen by nasal cannula at 4 liters per minute. Which of the following should be done next?

A) Give 81 mg aspirin by mouth.
B) Start precautionary IV of normal saline and transport.
C) Give 0.4 mg nitroglycerin sublingually.
D) Do a 12-lead ECG.