مريض عمره ٥٨ سنة ومريض ضغط، جاء بألم مفاجئ وصفه بأنه ممزق بين لوحي الكتف. ضغطه في الذراع اليمنى ١٨٢/١٠٤ وفي اليسرى ١٤٦/٨٨. أي أمر يتوقعه الممرض أولاً؟

A 58-year-old with hypertension presents with sudden pain he describes as tearing between the shoulder blades. BP is 182/104 in the right arm and 146/88 in the left. Which order does the nurse expect first?

1. Immediate thrombolysis after the ECG
2. A rapid IV antihypertensive with a beta-blocker
3. IV heparin to prevent clot formation
4. Chewed aspirin 300 mg with sublingual nitroglycerin every 5 minutes

Answer: B) A rapid IV antihypertensive with a beta-blocker. Tearing pain with an inter-arm pressure difference suggests aortic dissection. Heart rate is lowered first with an IV beta-blocker, then BP quickly, to limit propagation, while imaging and surgery are arranged. Anticoagulants and thrombolytics are contraindicated.