A 72-year old man comes to the emergency department of a tertiary care hospital. He complains of wea

Discussion in 'Step 3' started by samuel, Dec 5, 2014.

  1. samuel

    samuel New Member

    A 72-year old man comes to the emergency department of a tertiary care hospital. He complains of weakness and occasional dizziness over the past hour. He also reports nausea and hiccups that have been going on for several hours. On further questioning, he tells you about an odd feeling, “sort of like tingling,” that he has had in his left wrist for approximately an hour. He has no complaints of diarrhea, dysphagia, or abdominal pain. He has no history of injury to the arm. Past medical history is negative, other than an appendectomy when he was a young adult and an episode of pneumonia for which he required hospitalization approximately 3 years ago. He currently takes no medications other than occasional acetaminophen. Physical examination reveals the patient to be slightly diaphoretic. He is afebrile; other vital signs include blood pressure of 115/74 mm Hg, pulse of 55/min, and respirations of 16/min. Oxygen saturation is 96% on 2 liters of oxygen administered by nasal prongs. Other laboratory data include the following:



    Nitroglycerin is given, which results in elimination of the wrist discomfort. Following administration of nitroglycerin, the patient’s blood pressure is 112/70 mm Hg, his pulse is 50/min, and he no longer feels dizzy. The patient’s electrocardiogram is shown. Aspirin, intravenous heparin, and a glycoprotein IIb/IIIa inhibitor are administered. What additional therapy is indicated for the patient at this time?
    A. Atropine
    B. Beta-blocker
    C. Morphine
    D. Pacemaker
    E. Tissue plasminogen activator

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