# A 45-year-old male patient is admitted to the emergency department with chest pain that started 2 hours ago, reporting crushing chest pain radiating to his left arm and jaw, with associated nausea and diaphoresis. The ECG shows ST-segment elevation in leads II, III, and aVF. Which nursing action should be the highest priority?

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## 문제

A 45-year-old male patient is admitted to the emergency department with chest pain that started 2 hours ago, reporting crushing chest pain radiating to his left arm and jaw, with associated nausea and diaphoresis. The ECG shows ST-segment elevation in leads II, III, and aVF. Which nursing action should be the highest priority?

## 보기

1. Administer sublingual nitroglycerin as ordered
2. Obtain a 12-lead ECG every 15 minutes
3. Prepare the patient for cardiac catheterization **✔ 정답**
4. Establish IV access and draw blood for cardiac enzymes

**정답: 3**

## 해설

In STEMI, immediate preparation for cardiac catheterization is the priority to achieve reperfusion within 90 minutes. IV access and enzyme draws are important but secondary to urgent intervention.

## 심화 해설

Understanding the Clinical Scenario

The patient presents with crushing chest pain radiating to the left arm and jaw, accompanied by nausea and diaphoresis. The ECG reveals ST-segment elevation in leads II, III, and aVF. This presentation is a classic description of an acute ST-segment elevation myocardial infarction (STEMI) involving the inferior wall of the heart. In the context of an acute STEMI, the overriding goal of therapy is to restore blood flow to the occluded coronary artery as quickly as possible, a concept known as minimizing "time to reperfusion." The clinical guidelines and evidence strongly emphasize that the most critical determinant of patient survival and myocardial salvage is the speed with which the blocked artery is opened.

Analyzing the Priority Nursing Action

The question asks for the highest priority nursing action. Using an acute care prioritization framework, such as the ABCs (Airway, Breathing, Circulation) and considering time-sensitive interventions, the nurse must identify the action that definitively addresses the underlying cause of the circulatory compromise. While all listed options are important components of care for a patient with a suspected STEMI, they must be viewed through the lens of the ultimate goal: rapid reperfusion.

Why Preparing for Cardiac Catheterization is the Priority

The correct answer is to prepare the patient for cardiac catheterization. This action is the direct gateway to percutaneous coronary intervention (PCI), which is the preferred method of reperfusion when it can be performed in a timely manner. The foundational research underscores this priority. A study on care coordination for STEMI highlights that "rapid activation of the cardiac catheterization laboratory (CCL) for ST-segment elevation myocardial infarction (STEMI) is essential to minimize time to reperfusion" [1]. The nurse’s role in initiating this process—by activating the CCL team, ensuring the patient’s consent is obtained, and physically preparing the patient—is the most impactful action to reduce door-to-balloon time. Delays in this step directly translate to increased myocardial damage and worse patient outcomes.

Evaluating the Other Options

The other options are supportive and important but are secondary to the definitive intervention of reperfusion.

- Administering sublingual nitroglycerin (Option 1) can provide symptomatic relief from chest pain by causing vasodilation, but it does not treat the underlying thrombotic occlusion. It is a comfort measure, not a life-saving reperfusion strategy.

- Obtaining a 12-lead ECG every 15 minutes (Option 2) is a monitoring activity used to track the evolution of the infarction or to detect complications like arrhythmias. While crucial, continuous monitoring does not actively restore coronary blood flow. The diagnostic ECG showing STEMI has already been obtained, and the priority now shifts from diagnosis to treatment.

- Establishing IV access and drawing blood for cardiac enzymes (Option 4) is a fundamental nursing task. IV access is necessary for administering medications, and cardiac enzyme levels (like troponin) are part of the diagnostic criteria. However, the diagnosis of STEMI is made by the ECG, not by waiting for lab results. The evidence-based pre-examination process for acute chest pain focuses on streamlining these steps so they do not delay definitive care . These actions should be performed concurrently with, but not as a priority over, preparing for the catheterization lab.

Connecting to Clinical Practice and Patient Safety

The emphasis on rapid CCL activation also relates to system efficiency and patient safety. Efforts to reduce treatment delays have sometimes led to "false activations," where the CCL team is mobilized but an emergent coronary intervention is not performed. These false alarms contribute to "staff fatigue, workflow disruption, and inefficient resource use" [1]. However, the clinical priority for a patient with a clear STEMI presentation remains the rapid mobilization of this team, as the risk of delaying treatment for a true heart attack far outweighs the operational downsides of a potential false activation. The nurse’s clinical judgment in recognizing the classic inferior-wall STEMI pattern on the ECG is the critical trigger for this high-priority, time-sensitive action.References (research sources)

- [1]Impact of a Cloud-Based Care Coordination Platform on False Cardiac Catheterization Laboratory Activations and Unnecessary Team Mobilization: Retrospective Cohort Study.Research articleGibson W, Al Kindi D, Brouillette F, Aldajani A, Chaabo O, Lachance Y, Akl E, Dandona KB, Martucci G, Pelletier JP, Piazza N, Levett JY, Moran T, Spaziano M. (2026) · DOI: 10.2196/76932

## 임상 시나리오

STEMI Reperfusion PriorityMinimizing Time to PCI
For a patient with an acute STEMI, the highest priority is to restore blood flow. The definitive treatment is percutaneous coronary intervention (PCI). All nursing actions must focus on facilitating rapid transfer to the cardiac catheterization lab to meet a door-to-balloon time of 90 minutes or less.

CautionDo not delay catheterization for serial ECGs or awaiting all lab results. Preparing the patient (consent, skin prep, shaving) should begin immediately upon STEMI identification.

## 핵심 개념

- **STEMI** — ST-segment elevation myocardial infarction; a complete occlusion of a coronary artery causing transmural ischemia, diagnosed by characteristic ECG changes.
- **Reperfusion Therapy** — The process of restoring blood flow to an occluded coronary artery, either mechanically via PCI or pharmacologically via fibrinolytics, to limit infarct size.
- **Cardiac Catheterization** — An invasive procedure where a catheter is threaded to the heart to visualize coronary arteries, often followed by PCI to open blockages.
- **Door-to-Balloon Time** — A quality metric representing the time from a patient's arrival to the inflation of a balloon in the occluded artery during PCI; a key target for STEMI care.

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