رجل عمره ٥٨ سنة، مدخن ومصاب بارتفاع الضغط، وصل للطوارئ بألم ضاغط في وسط الصدر منذ ٢٠ دقيقة ينتشر للفك، مع تعرق غزير وغثيان. العلامات الحيوية: الضغط ١٤٦/٩٢، النبض ١٠٤، التنفس ٢٢، التشبع ٩٥٪. ما الأولوية خلال أول ١٠ دقائق من وصوله؟

A 58-year-old man who smokes and has hypertension arrives with 20 minutes of central crushing chest pain radiating to the jaw, with heavy sweating and nausea. Vitals: BP 146/92, HR 104, RR 22, SpO2 95%. What is the priority within the first 10 minutes of arrival?

1. Give morphine 4 mg IV before any other intervention
2. Draw a troponin and wait for the result before any other test
3. Get a chest X-ray first to exclude aortic dissection
4. Obtain a 12-lead ECG

Answer: D) Obtain a 12-lead ECG. An ECG within 10 minutes of arrival detects STEMI, which needs rapid reperfusion. Troponin may be normal early and is not awaited, morphine is not a first step, and the X-ray does not come before the ECG.