Presentation on theme: "Ruling Out a Myocardial Infarction"—
Ruling Out a Myocardial Infarction
Jill, Kara, Jenna, Hoda
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 oor with a
diagnosis of rule out myocardial infarction (R/O MI). He has signicant 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 ne in a loud and angry voice and demands a cigarette.
1. From the perspective of basic human needs, what is the first priority of his care?
2. Are these VS reasonable for a man his age
2. Are these VS reasonable for a man his age? If not, which one(s) concern(s) you? Explain why or