一位 55 歲高血壓病史病患主訴突發性「壓迫感」胸痛放射至左臂，護理師的首要行動為何？

病人主訴的「壓迫感」胸痛（crushing chest pain）並放射至左臂，伴隨高血壓病史，高度懷疑為急性冠心症（Acute Coronary Syndrome, ACS），包括不穩定型心絞痛（unstable angina）或心肌梗塞（myocardial infarction）。在這種情況下，時間就是心肌（time is muscle），迅速且準確的診斷是挽救心肌、降低死亡率的關鍵。12 導程心電圖（12-lead ECG）是診斷 ACS 最快速、最直接的工具，它能提供心臟電氣活動的詳細資訊，幫助判斷是否存在心肌缺氧（ischemia）、心肌損傷（injury）或心肌梗塞（infarction），並能識別受影響的心臟區域。及早完成 ECG 有助於決定是否需要立即進行血管再灌流治療，如緊急心導管檢查（cardiac catheterization）或血栓溶解劑（thrombolytic agent）的使用。 雖然給予阿斯匹靈（aspirin）和硝化甘油（nitroglycerin）是 ACS 的標準藥物治療，且測量生命徵象（vital signs）也是重要的評估步驟，但這些行動的執行都應該在 ECG 診斷的基礎上進行。ECG 的結果將指導後續的藥物選擇與劑量，並確認病人是否適合使用硝化甘油（例如，排除右心室心梗）。因此，在病人出現疑似 ACS 症狀時，獲得 12 導程 ECG 是護理師的首要行動，它為後續所有診斷與治療決策提供了最關鍵的依據。

The client's complaint of 'crushing' chest pain radiating to the left arm, combined with a history of hypertension, is highly suggestive of acute coronary syndrome (ACS), including unstable angina or myocardial infarction. In this situation, 'time is muscle,' and rapid, accurate diagnosis is key to salvaging myocardium and reducing mortality. The 12-lead ECG is the fastest and most direct tool for diagnosing ACS; it provides detailed information about the heart's electrical activity, helps determine whether myocardial ischemia, injury, or infarction is present, and identifies the affected cardiac region. Obtaining the ECG early helps decide whether immediate reperfusion therapy is needed, such as urgent cardiac catheterization or thrombolytic therapy. Although aspirin and nitroglycerin are standard pharmacologic treatments for ACS, and measurement of vital signs is also an important assessment step, these actions should follow the ECG diagnosis. The ECG findings guide subsequent drug choices and dosing and confirm whether the client is a candidate for nitroglycerin (for example, ruling out right ventricular infarction). Therefore, when a client presents with suspected ACS symptoms, obtaining a 12-lead ECG is the nurse's priority action and provides the most critical basis for all subsequent diagnostic and therapeutic decisions.