Case Study: Rule Out Myocardial Infarction
The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily
all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in
good weather), have been grounded by the weather until morning. The roads are barely
passable. W.R., a 48-year-old construction worker with a 36-pack-year smoking history, is
admitted to your ﬂoor with a diagnosis of rule out myocardial infarction (R/O MI). He has
significant male-pattern obesity (“beer belly,” large waist circumference) and a barrel chest, and
he reports a dietary history of high-fat food. His wife brought him to the emergency department
(ED) after he complained of (C/O) unrelieved “indigestion.” His admission vital signs (VS) were
202/124, 96, 18, and 98.2° F. W.R. was put on oxygen (O2) by nasal cannula (NC) titrated to
maintain SaO2 (arterial oxygen saturation) over 90%, and an IV of nitroglycerin (NTG) was
started in the ED. He was also given aspirin 325 mg and was admitted to Dr. A.’s service. There
are plans to transfer him by helicopter to the regional medical center for a cardiac
catheterization in the morning when the weather clears. Meanwhile you have to deal with limited
laboratory and pharmacy resources. The minute W.R. comes through the door of your unit, he
announces he’s just fi ne in a loud and angry voice and demands a cigarette.
1. From the perspective of basic human needs, what is the first priority in his care?
2. Are these VS reasonable for a man his age? If not, which one(s) concern(s) you? Explain why
or why not.
3. Identify five priority problems associated with the care of a patient like W.R.