Atlas · Plate XIII · Medical Emergencies · 03
Cardiac emergencies
Angina is chest pain under stress, treated with nitroglycerin 0.4 mg under the tongue every 5 minutes, up to three doses, after checking that systolic pressure is above about 90 mmHg. Pain that persists suggests a heart attack: call EMS, have the patient chew 162-325 mg of aspirin if not allergic, and prepare for CPR and the AED. Women, diabetics and older adults often have atypical symptoms.
High-yield facts · 6
- Angina: chest pain under stress lasting a few minutes; give nitroglycerin 0.4 mg sublingual (tablet or spray) every 5 min, up to 3 doses.T8
- Check BP before nitroglycerin; do not give it if systolic is under about 90 mmHg or after recent PDE-5 inhibitors (sildenafil within 24 h).T8
- Suspected MI: pain unrelieved by 3 doses of nitroglycerin, often radiating to the left arm, jaw or back; call EMS.T8S26
- MI management: give 162-325 mg chewed aspirin if not allergic, oxygen if hypoxic, keep the patient comfortable, prepare for CPR and the AED.S26T8
- Women, diabetics and older patients more often have atypical MI symptoms (fatigue, nausea, shortness of breath).S26
- Elective dental care is usually deferred for about 6 months after an MI or stroke and limited for unstable angina.T8T1
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