First aid for a heart attack

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:

Your elderly relative complained of feeling unwell. When questioning him, you found out that he had complaints of chest pain of a compressive nature radiating to the left shoulder, weakness, and sweating. The pain began while working in the garden. A 65-year-old man has arterial hypertension. A man today took the drug lisinopril prescribed by his doctor. There is a first aid kit containing nitroglycerin and acetylsalicylic acid. A blood pressure measuring device is available. Provide first aid.

Equipment for the practical skill:

• simulated patient;
• universal first aid kit;
• blood pressure measuring device.

• Help the casualty stop what he is doing and sit down.
• Examine the casualty:
  • clarify complaints, paying attention to chest pain, weakness, dizziness, drowsiness, nausea, shortness of breath;
  • clarify information about the person’s chronic diseases, paying attention to arterial hypertension, angina pectoris, and previous myocardial infarctions;
  • determine the color, temperature and moisture content of the skin, pay attention to the presence of cyanosis of the lips and fingertips;
  • check the radial pulse;
  • measure the person's blood pressure.
• Identify a type of the problem: there are signs of an angina pectoris and a heart attack – it is necessary to clarify the diagnosis and provide first aid in accordance with this diagnosis.
• Reassure the casualty.
• Give the person nitroglycerin:
  • if systolic blood pressure is more than 100 mmHg give the person the nitroglycerin tablet and ask him to place it under his tongue until it dissolve completely;
  • after the tablet has completely dissolved (approximately 5 minutes), clarify his complaints and measure his blood pressure;
  • if systolic blood pressure is more than 100 mmHg give the person second nitroglycerin tablet and ask him to place it under his tongue until it dissolve completely;
  • after second tablet has completely dissolved (approximately 5 minutes), clarify his complaints and measure his blood pressure;
  • if systolic blood pressure is more than 100 mmHg give the person third nitroglycerin tablet and ask him to place it under his tongue until it dissolve completely;
  • clarify his complaints.
• Make a diagnosis:
  • If the pain is relieved, diagnose an angina pectoris and advise the person to contact his doctor and tell him about his angina attack.
  • If the pain is not relieved after three doses (over about 15 minutes), suspect a heart attack and call 103 immediately.
  • If you suspect a heart attack, give to person acetylsalicylic acid:
  • ask the person if they have an allergic reaction to acetylsalicylic acid – do not give acetylsalicylic acid to the person if he has allergic to it;
  • ask the person if he took acetylsalicylic acid at the recommended dose today – do not give acetylsalicylic acid to the person if he took this medicine today at the recommended dose;
  • if there is no allergic reaction and acetylsalicylic acid was not taken today take to person an oral dose of 300 mg acetylsalicylic acid – suggest the person the person to chew the tablet in their mouth and then drink it with water.
• Reassure the person and monitor vital signs – breathing, pulse, and level of response – while waiting for help to arrive.