Chest Tightness During a Training Session
A 52-year-old male client is 12 minutes into a moderate-intensity stationary bike session at RPE 13 when he stops pedaling and says he feels 'pressure' in the center of his chest, mildly nauseated, and the discomfort spreads to his jaw. He is pale and sweaty. He has no known heart disease but has hypertension and a 20-year smoking history; he took his usual lisinopril this morning. His resting BP before exercise was 148/92, HR 76. The gym is quiet, you are the only staff member on the floor, and the AED is mounted 15 meters away. He says, 'I'll just sit for a minute; I don't want to make a fuss.'
1. List, in order, your immediate actions and the rationale for each.
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- Stop the session and keep him seated or lying comfortably; do not let him walk. 2) Call 911/EMS immediately and state 'chest pressure with jaw radiation and nausea.' 3) Retrieve the AED and bring it to him; monitor responsiveness and breathing. 4) Stay with him, loosen clothing, and be ready to start CPR/AED if he becomes unresponsive. 5) Do not give food or drink or nitroglycerin unless it is his prescribed medication and EMS directs. Rationale: these are classic acute coronary syndrome signs; time to reperfusion matters, and continued exertion increases cardiac demand.
2. What documentation and follow-up are required after EMS takes over?
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Complete an incident report with time of onset, symptoms, vitals, actions taken, EMS arrival, and witnesses. Notify the facility manager and keep the record confidential. Do not diagnose or advise return to exercise. Require written medical clearance before he resumes training, and follow your facility's emergency action plan debrief.
3. How would you change your pre-participation screening and session monitoring for similar clients in the future?
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Use a PAR-Q+ and health-history form for each new client, check BP and symptoms before sessions for hypertensive clients, and require medical clearance when indicated. Know the emergency action plan, AED location, and practice it. During sessions, monitor RPE, talk test, and symptoms; stop for chest pain, unusual dyspnea, dizziness, or pallor. For this client, resting BP 148/92 plus age and smoking history should have triggered clearance before moderate exercise.