A 26-year-old male presents to the ED with complaints of sho…

A 26-year-old male presents to the ED with complaints of shortness of breath and right-sided chest pain that began after a 2-mile run. The symptoms have been persistent for the past 3 hours. Pain is increased with inspiration. He denies any constitutional symptoms of fever, cough, chills, or sick contacts. He is an avid runner on a daily basis, but does smoke ½-pack of cigarettes per day. On physical exam he is tachypneic, with respiratory rate 30, 94% saturation on room air. Breath sounds are decreased in the left lung fields, and there is hyperresonance to percussion. The AG-ACNP obtains the following chest x-ray: CXR1.jpg What is the diagnosis?

A 58-year-old male is seen in the ED for syncope. His wife r…

A 58-year-old male is seen in the ED for syncope. His wife reports that she was in the kitchen when she heard him fall on the living room floor. He recalls feeling very lightheaded but remembers nothing more. Upon further questioning, he recalls feeling dizzy on several occasions over the past few months. He has a history of hypertension and a myocardial infarction 10 years earlier. He has since been well and exercises on a daily basis. In the ED, he has a blood pressure of 95/55 mmHg and a heart rate of 30 beats/min. An ECG is obtained (see the following ECG).  ECG1.jpg What is the most important initial step in managing this patient?