Blog

A 76-year-old female undergoes uncomplicated coronary angiography via the right femoral artery for evaluation of a newly diagnosed cardiomyopathy. She is found to be without obstructive coronary artery disease. The patient is admitted to the intensive care unit for further monitoring. Her femoral angiogram is shown in the figure that follows. Angio2.jpg Two days following admission, the patient begins to cough. Shortly thereafter, she is observed to have sudden and rapid expansion of her right lower quadrant, with associated hypotension. Which of the following is the most appropriate next step?

ECG12.gif Based on the findings of this electrocardiogram, identify which coronary artery is affected:

A 69-year-old male patient presents with severe dyspnea, respiratory rate 32, SaO2 84%, heart rate 112, a blood pressure of 82/50, cold extremities, and confusion. After examining the patient, he begins to cough pink-tinged sputum. This scenario reflects:

All of the following conditions can cause secondary hypertension except:

You are being emergently called to the bedside of a 52-year-old otherwise healthy female who underwent a thoracotomy for left lower lobectomy for non-small-cell lung cancer one day ago. According to the nurse, the patient received a 2mg IV hydromorphone bolus 30 minutes ago. You find a somnolent patient, with a respiratory rate of 12/min, stable oxygen saturation of 97% on room air. The patient’s heart rate is 167 beats/min and irregular, blood pressure 73/34 mmHg. An ECG confirms the new diagnosis of atrial fibrillation (AF). The nurse states that the tachycardia started about 5 minutes ago.  Which would be the MOST appropriate next step?

A 22-year-old male is admitted to the intensive care unit after sustaining a cardiac arrest while playing soccer in a rural area. Cardiopulmonary resuscitation was performed, but no automatic external defibrillator was available; he was intubated in the field because of poor mental status. He is transferred to your tertiary care ICU. Examination reveals an ejection systolic murmur, and he followed commands when sedation was lightened. Transthoracic echocardiography reveals discrete upper septal hypertrophy measuring 18 mm and an elevated left ventricular outflow velocity. He successfully passes a spontaneous awakening trial and spontaneous breathing trial. Unfortunately, at that time, he develops atrial fibrillation, became hypotensive to blood pressures of 94/52, and FiO2 was increased from 0.4 to 0.6 in response to desaturations to the low 80s. The best treatment for this patient’s atrial fibrillation is:

A 24-year-old female presents to the ED with a complaint of, “My heart is pounding out of my chest and I’ve been short of breath for 4 hours.” She has had similar episodes, but all have spontaneously stopped. She is in good health and takes no medications. Her blood pressure is 120/80 mmHg and pulse too rapid to count. Her rhythm is shown in the following ECG. ECG2.jpg What is the most appropriate immediate management for this patient?

An elderly patient with septic shock from a urinary source is admitted into the ICU. The physical exam findings are suggestive of a fluid depleted state. Microbiologic cultures are obtained and antibiotics are initiated. A central line is placed, and CVP is measured at 6 mmHg.  What is the optimal next best step?

A 56-year-old male presents to the ED with substernal chest pain, pain with inspiration, systolic apical murmur, and fever. His ECG demonstrates ST segment elevation in all leads.  This should be recognized as:

Which of the following is true regarding symptomatic bradycardia?