Advanced Cardiovascular Life Support (ACLS) Practice Exam

A 49-year-old man presents with retrosternal chest pain radiating to the left arm and shows signs of diaphoresis. What should be the next action after administering 160 mg of aspirin and establishing a peripheral IV?

1. Administer 2 to 4 mg of morphine by slow IV bolus

2. Administer nitroglycerin

3. Prepare for emergency cardiology consultation

4. Start immediate CPR

The correct answer is: Administer 2 to 4 mg of morphine by slow IV bolus

The next crucial action after administering aspirin and establishing a peripheral IV in a patient presenting with chest pain and diaphoresis is to administer morphine. Morphine serves several important roles in the management of acute coronary syndrome. Firstly, it acts as an effective analgesic, helping to alleviate severe pain associated with conditions like myocardial infarction. This pain relief can reduce the sympathetic nervous system response, which may otherwise worsen the patient's condition. Additionally, morphine has vasodilatory effects, which can help reduce myocardial oxygen demand by decreasing preload and afterload. This can be particularly beneficial in cases of acute myocardial ischemia, where the heart's oxygen supply is compromised. In contrast, while nitroglycerin is also used in this scenario, it may not be the first choice due to potential hypotension, especially in patients who have not been thoroughly assessed for right ventricular involvement, which could complicate their condition. Emergency cardiology consultation may be warranted later; however, it does not directly address the immediate symptom relief needed. Starting immediate CPR would only be reserved for patients who exhibit signs of cardiac arrest, which is not indicated in this scenario, as the patient is still conscious and presenting with symptoms rather than showing signs of profound distress or unresponsiveness.