Five minutes after the first NTG tablet, B.T. states that the ...

[ashley]

Five minutes after the first NTG tablet, B.T. states that the discomfort is still there and only slightly relieved. Explain what you can expect to be doing while waiting for emergency medical system (EMS) personnel to arrive.
 
  Also what other actions will you take at this time?

Question 2

B.T. is still uncomfortable, and he has an unopened bottle of sublingual nitroglycerin (SLNTG) tablets. His blood pressure is 158/98, and his pulse is 122.
 
  You decide to give him one tablet. After 5 minutes, which is the appropriate action to take?
 
  a. If the chest discomfort is relieved, call 911.
  b. If the chest discomfort is not relieved, give another SL NTG tablet, and wait 5 minutes more.
  c. If the chest discomfort is not relieved, have someone else call 911 while you give B.T. another SL NTG tablet.
  d. If the chest discomfort is not relieved, obtain a 12-lead electrocardiogram (ECG) to look
  for ischemic changes, and call 911.

[debra928]

Answer to Question 1

 Have one nurse call 911 and request emergency transport to the nearest emergency department
(ED) while you stay with B.T.
 Have B.T. chew two low-dose (81 mg, or baby) aspirin tablets, if available.
 Following the department protocols, while you are waiting for the medics, start 2 to 4 L of O2/NC
and establish intravenous (IV) access, in case IV medications have to be administered.
 Run a 12-lead ECG or rhythm strip to look for dysrhythmias and ischemic changes. Run a long
rhythm strip. If B.T. needs to be transported by the paramedics to the ED, it may be valuable to the
medical personnel at the hospital.
 Continue to observe B.T. carefully and monitor his vital signs, reassure him, and make him as
comfortable as possible.
 Notify B.T.'s attending physician and his wife.

Continue to monitor his vital signs, and consider checking a 12-lead ECG (if available) to look for
ischemic changes. Keep him quiet, and reassure him that you will stay with him.

Answer to Question 2

Answer: c
According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after
one dose of SL NTG, call 911 immediately. The patient can take one more tablet while awaiting
emergency care, and a third tablet 5 minutes later, but no more than three tablets total. These
guidelines reflect the fact that angina pain that does not respond to NTG might indicate that an MI is
occurring.