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? 

An 83-year-old male who was on the telemetry unit for a hear…

An 83-year-old male who was on the telemetry unit for a heart failure exacerbation has been transferred to the intensive care unit due to new onset atrial fibrillation with a rapid ventricular response. He was given a diltiazem bolus followed by a continuous diltiazem infusion without successful rate control. It has been less than 48 hours and direct current cardioversion is being considered. The success of electrical cardioversion is inversely proportional to which of the following?

The AG-ACNP is seeing a 70-year-old female patient with a si…

The AG-ACNP is seeing a 70-year-old female patient with a significant history of COPD and 3 months status post right total knee replacement who woke up this morning with severe dyspnea. The chest x-ray was inconclusive of pertinent findings, therefore a CT of the chest was completed. The CT angiogram of the chest was positive for a pulmonary embolism in the right upper lobe. Two hours later the patient’s vital signs changed and she is now tachycardic to 130s, blood pressure 64/48, respiratory rate 30, SaO2 80%. The AG-ACNP identifies this type of shock as:

A 24-year-old female presents to the ED with a complaint of,…

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?