مريض عمره ٦٦ سنة وصل الطوارئ بألم صدري منذ ٤٠ دقيقة. التخطيط يظهر ارتفاع ST في II وIII وaVF. الضغط ٨٤/٥٠ والنبض ٥٨، والرئتان صافيتان، والأوردة الوداجية منتفخة. أي أمر يتوقعه الممرض أولاً؟

A 66-year-old man reaches the ED after 40 minutes of chest pain. The ECG shows ST elevation in II, III and aVF. BP is 84/50, HR 58, lungs are clear and the jugular veins are distended. Which order does the nurse anticipate first?

1. IV furosemide to relieve the jugular venous distension
2. IV morphine, then high Fowler’s position
3. Sublingual nitroglycerin every 5 minutes until the pain resolves
4. A rapid IV normal saline bolus with blood pressure monitoring

Answer: D) A rapid IV normal saline bolus with blood pressure monitoring. Inferior ST elevation with hypotension, clear lungs and raised JVP points to right ventricular infarction. The RV depends on preload, so it needs fluid. Nitrates, morphine and diuretics all reduce preload and drop the pressure further.