Two days after admission for myocardial infarction and subsequent coronary angioplasty, a 65-year-old man becomes distressed and diaphoretic in the cardiac intensive care unit. Suddenly he is no longer responsive. Pulse oximetry does not show a tracing. He has a history of hypertension and depression. Prior to his admission, his medication included ramipril and aripiprazole. Examination shows no carotid pulse. An ECG is shown. After beginning chest compressions, which of the following is the most appropriate step in management of the patient?
AIntravenous procainamide
BCardiac catheterization
CIntravenous amiodarone
DIntravenous magnesium sulfate
EDefibrillation
A 40-year-old Caucasian male presents to the emergency room after being shot in the arm in a hunting accident. His shirt is soaked through with blood. He has a blood pressure of 65/40, a heart rate of 122, and his skin is pale, cool to the touch, and moist. This patient is most likely experiencing all of the following EXCEPT:
ADecreased sarcomere length in the myocardium
BIncreased stroke volume
CConfusion and irritability
DDecreased preload
EIncreased thromboxane A2
A 27-year-old man is brought to the emergency department 30 minutes after being shot in the abdomen during a violent altercation. His temperature is 36.5°C (97.7°F), pulse is 118/min and regular, and blood pressure is 88/65 mm Hg. Examination shows cool extremities. Abdominal examination shows a 2.5-cm entrance wound in the left upper quadrant at the midclavicular line, below the left costal margin. Focused ultrasound shows free fluid in the left upper quadrant. Which of the following sets of hemodynamic changes is most likely in this patient? Cardiac output (CO) | Pulmonary capillary wedge pressure (PCWP) | Systemic vascular resistance (SVR) | Central venous pressure (CVP)
A↑ ↓ ↓ ↓
B↓ ↓ ↑ ↑
C↓ ↓ ↓ ↓
D↓ ↓ ↑ ↓
E↓ ↑ ↑ ↑
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