1. Prior to administering GTN to Leonard, what are the relevant considerations regarding the following;
1. The appropriate dose and frequency of administration?
2. The patient’s vital signs and history (particularly medications)?

Explain in point form:
0. The mechanism of action of GTN.
1. The physiological rationale for administering GTN (i.e. what is the intended physiological outcome of administering GTN).
2. The rationale for the sublingual route of administration of GTN.
Include all sources of information in your response.
Once you have administered the GTN to Leonard, you perform a 12-lead ECG which differs from your initial 3-lead ECG and presents a clinical picture consistent with the sample ECG shown in Figure 1.

Figure 1. Example of a 12-lead ECG obtained from an individual experiencing Leonard’s condition

Question
3. Interpret the ECG shown in Figure 1 and provide your provisional diagnosis. What are your immediate transport considerations for Leonard?
5 minutes after commencing GTN, Leonard describes his pain as a 5 (previously an 8). After rechecking Leonard’s blood pressure again (128/79mmHg), you load Leonard into the ambulance to drive him to Flinders Medical Centre, undertaking an on-going assessment and treatment en-route: