A 58-year-old client arrives by EMS at 0842. He reports substernal pressure unchanged for 45 minutes despite resting since onset, with discomfort that spreads down the left arm and new breathlessness while sitting still. EMS gave chewable aspirin 324 mg before arrival. History includes hypertension, hyperlipidemia, and a 30-pack-year smoking history; he takes lisinopril and atorvastatin daily, and his father had a myocardial infarction at 62. A clinic note from last month lists BP 150/92, a resting HR of 68, and SpO2 93 percent on room air. Current findings: BP 152/94 in the right arm, HR 102 and regular, RR 20, T 37.0 C, and SpO2 93 percent, same as his clinic value with unlabored breathing. Lung sounds are clear, and there is trace ankle edema, unchanged from last month. He has pale, cool skin with diaphoresis and is anxious and asks if this is a heart attack.
一名58歲的個案於0842由救護車送達。他主訴自發病以來休息後，胸骨下壓力持續45分鐘未變，伴隨不適感擴散至左臂，以及靜坐時出現新的呼吸困難。救護車在抵達前給予324毫克咀嚼式阿斯匹靈。病史包括高血壓、高血脂，以及30包年吸菸史；他每天服用賴諾普利和阿托伐他汀；他的父親在62歲時曾發生心肌梗塞。上個月的門診紀錄顯示血壓150/92毫米汞柱，靜息心率68次/分，室內空氣下血氧飽和度93%。目前發現：右臂血壓152/94毫米汞柱，心率102次/分且規律，呼吸頻率20次/分，體溫37.0°C，以及血氧飽和度93%，與其門診值相同，呼吸不費力。肺音清晰，且有微量腳踝水腫，與上個月相比沒有變化。他有蒼白、冰冷的皮膚伴隨出汗，且焦慮並詢問這是否是心臟病發作。