65-year-old Robert B. has a history of chronic stable angina…

65-year-old Robert B. has a history of chronic stable angina and was admitted to the hospital two days ago for observation for an unrelated urology problem. This afternoon Dr. Snow tried to do a minor procedure in the patient’s room.  During the procedure he administered IV atropine. Dr. Snow calls you into the room in a panic because Robert is now clutching his own chest and crying out, “Ah!  My normal angina chest pain is back but it is much worse; I feel like an elephant is crushing my chest!  This moron Dr. Snow says gave me the normal pill I use when I have my angina pain but it didn’t help!  I’m dying!  Get me a real doctor!”   A.  What is Robert B.’s current acute problem?

(5 points) Ned sits down on the end of the hospital bed and…

(5 points) Ned sits down on the end of the hospital bed and tells Dr. Snow to stop asking about the propranolol he takes every day for his migraine because he has chest pain.    Dr. Snow (foolishly) decides Ned must have PTSD from being a war veteran and googles “PTSD in old men” on his smartphone.  A user called “DoctorFromOhio” on www.reddit.com suggests alpha-blockers are good for PTSD.  Dr. Snow shrugs, gives Ned a dose of IV terazosin, and turns away to type into the hospital computer.  Moments later Ned falls to the floor on his face, unconscious.   Dr. Snow immediately checks Ned pulse.  What happens?    (Stop! Only about 1/5 students get this question correct.  Take a second to think about it.  Figure out the BP change due to the IV terazosin in this patient who is already taking propranolol, then determine the heart rate reflex to see if it changed from 60 beats per minute.)   What is Ned’s heart rate when Dr. Snow checks it?