"arterial disease. Literature suggests that clopidogrel interacts with proton pump inhibitors(PPIs) like omeprazole and esomeprazole. Therefore, these medications should not be takensimultaneously as PPIs decreases the effectiveness of clopidogrel. Analysis of Patient Treatment:Upon arrival to the emergency department, the patient was identified as category 1 and wasattended by the doctor within 2 minutes. All the patients with life threating conditions areidentified as Category 1. Initially, Airway, breathing, circulation and other vital signs shouldbe checked and should be maintained as they are the first-level priority problems (Lake, et al.,2009). So, the patient is administered oxygen via Hudson mask.A simple mask such asHudson mask or venticare MC is used to deliver oxygen to patients with pneumonia, chestpain and moderate asthma maintaining the oxygen flow rate at 12-15L/min. The primary aimof this intervention is to achieve an oxygen saturation of 94-98%. If the patient’s conditionimproves, then nasal prongs or venture mask can be used with less oxygen flow rate (Walley,2011). Then the second level priority problems such as acute pain, changes in mental status,elimination problem and risk of infection should be addressed. Later, Third-level priorityproblems such as coping, family coping, activity, and rest should be addressed by the nurse.Therefore, the health care professionals performed pain assessment in the patient using a painrating scale. A score of 8 indicates that patient is experiencing intense pain. The initialtreatment for acute coronary syndrome aims to stabilize the patient’s condition by relievingischemic pain and providing antithrombotic medications to reduce the myocardial damageand prevent ischemia. Morphine or Fentanyl is administered for pain control. Usually,morphine is given when the pain is not controlled by the nitroglycerin. Smaller dosesadminister (2-4 mg morphine) of morphine are more often than larger doses. Morphine is anopioid medication which binds to the receptors in the brain and decreases the perception ofpain. It has a sedating effect and may cause respiratory depression. So, the respiratory status should be monitored continuously along with pulse oxymeter. Morphine increases the risk ofhypotension in patients with an inferior myocardial infraction. Therefore, to rule out thepresence of inferior MI, a 12-lead ECG should be obtained (Song, et al., 2016).Following pain assessment, the nurse should check the changes in the mental state usingGlasgow Coma scale. A Glasgow coma scale (GCS) helps to assess the level ofconsciousness in a patient. A score of 15 on GCS indicates that the patient is alert. All thepatients with symptoms of the acute coronary disease should undergo 12 lead ECGexaminations immediately upon admission in the emergency department. Acute myocardialinfarction, Coronary vasospasm (Printzmetal’s angina), Pericarditis, Benign earlyrepolarisation, Left bundle branch block, Left ventricular hypertrophy, Ventricular aneurysm,Brugada Syndrome, Ventricular paced rhythm and Raised intracranial pressure causes anelevation in ST segment. Glycerine trinitrate or nitroglycerine is used as a first-line medication for the treatment of theacute coronary syndrome. It decreases chest pain and causes arterial and venous dilationfurther, reducing the workload of the heart (Jade, et al., 2015). It reduces myocardial oxygendemand. Glycerintrinitrate (GTN) therapy is always initiated at an infusion rate of 1mh or1mL per hour. The nurse should monitor the patient for first 5 minutes after initiating thetherapy to check the signs of sensitivity such as a decrease in blood pressure, palediscolouration of the skin, and dizziness. The dose of GTN should be adjusted as per thepatient’s response. It is important to always maintain the patient’s systolic blood pressureabove 90mmHG while administering GNT. Recent studies suggested that a loading dose of 600 mg clopidogrel decrease the risk ofadverse ischemic events in patients undergoing primary percutaneous coronary interventionfor ST-segment elevation myocardial infarction (STEMI) (Song, et al., 2012). Few studies also proved that a 600 mg loading dose of clopidogrel significantly inhibited plateletaggregation in patients with or without chronic clopidogrel therapy. Therefore, a loading doseof 600 mg clopidogrel will be helpful to reduce the risk of stroke in the patient. Aspirin is also used as an initial treatment for acute coronary syndrome. It decreases plateletaggregation and prevents the formation of a clot. A dose of 160 to 325 mg of aspirin shouldbe administered to prevent the risk of stroke. However, aspirin therapy is contraindicated inthe patients with the bleeding disorder, active peptic ulcer disease and hepatic disease(Hwang, et al., 2015).An angiogram is an X-ray method, which produces the images of blood vessels with the helpof a contrast material. It helps to identify coronary artery blockage, atherosclerosis, internalbleeding, and aneurysms. It helps the physician to determine best treatment option for thepatient. In the give case study, the angiogram reports suggest that patient has a blockage inthe left anterior descending artery. The left anterior descending artery is one of the mostcommonly occluded coronary arteries. Blockage of the left anterior descending coronaryartery can result in death as it provides a major supply of blood to the interventricular septum,right and left bundle branches of the heart, and anterior papillary muscle of the bicuspidvalve. A stent is often used to relieve the left anterior descending artery blockage. It isidentified as a safe and effective treatment option in long term analysis with high survivalrate and less incidence of revascularization. Some of the common complications or risk associated with angioplasty and stents arerestenosis, the formation of blood clots within stents after the procedure, and bleeding in theleg or arm where the catheter was inserted. Some of the rare complications are a heart attackduring the procedure, coronary artery damage, renal damage due to the dye used duringangioplasty and stent placement, stroke, and abnormal heart rhythms (Byrne et al., 2015). "