You have just arrived for a 12-hour day shift in the Coronary Care Unit (CCU) in the small hospital where you work. You take report on Mr. Whiting. Mr. Whiting is a new admission, transferred from the Emergency Department (ED) a short time ago.At 3:00 AM this morning, Mr. Whiting awoke from sleep with chest pain. Pain was accompanied by diaphoresis and nausea. He took Maalox without relief, then two of his wife's sublingual nitroglycerin tablets without relief (turns out they had expired). Mrs. Whiting finally called 911.Paramedics received Mr. Whiting at 5:30 AM in sinus tachycardia with a BP of 106/70. Mr. Whiting was alert, anxious, and diaphoretic, with pain rated as 10 out of 10.Paramedics initiated an IV of normal saline at the right antecubital fossa and administered two translingual sprays of nitroglycerin with a result of complete pain relief. SpO2 was 94% on room air. Oxygen was applied at 2 liters per minute by nasal cannula, elevating Mr. Whiting's SpO2 to 98%.In transit, Mr. Whiting's chest pain returned. Another spray of nitroglycerin was administered, but this time pain was unrelieved. Paramedics then administered morphine IV for pain relief.
