198.An 85-year-old man is rambling incoherently and not eating at his
nursing home. Records indicate that he has a past medical history of hyper-
tension, diabetes, dementia, and benign prostatic hypertrophy. On arrival to
the ED, the patient is combative and oriented only to name. His temperature
is 101°F rectally, BP is 85/50 mm Hg, HR is 125 beats per minute, RR is
22 breathsper minute, and blood sugar is 154 mg/dL. He appears uncom-
fortable and cachectic. His lungs are clear to auscultation, with scant crack-
les at the bases, and his abdomen is soft, nontender, and nondistended. He
has a Foley catheter in place draining cloudy, white urine. He has no periph-
eral edema. Which of the following is the most likely diagnosis?
a. Hypovolemic shock
b. Neurogenic shock
c. Cardiogenic shock
d. Anaphylactic shock
e. Septic shock
199.A 72-year-old man is in the ED for the evaluation of generalized
weakness over the previous 24 hours. He has a past medical history of
coronary artery disease with a CABG performed 5 years ago, diabetes mel-
litus, and arthritis. The nurse places the patient on a cardiac monitor and
begins to get his vital signs. While the nurse is obtaining the vital signs, he
notices the patient suddenly becomes unresponsive. You arrive at the bed-
side, look at the monitor, and see the following rhythm. Which of the fol-
lowing is the most appropriate next step in management?
Shock and Resuscitation 211a. Wait 5 minutes to see if he awakens on his own.
b. Immediately defibrillate at 200 J (biphasic).
c. Perform synchronized cardioversion at 100 J.
d. Immediately intubate the patient.
e. Insert an IV line and administer amiodarone.