18.A 27-year-old man who is otherwise healthy presents to the ED with a
laceration on his thumb that he sustained while cutting a bagel. You irrigate
and repair the wound and are about to discharge the patient when he asks
you if he can receive an ECG. It is not busy in the ED so you perform the
ECG, as seen below. Which of the following is the most appropriate next
step in management?
Chest Pain and Cardiac Dysrhythmias 11a. Admit the patient for placement of a pacemaker.
b. Admit the patient for a 24-hour observation period.
c. Administer aspirin and send cardiac biomarkers.
d. Repeat the ECG because of incorrect lead placement.
e. Discharge the patient home.
19.A 56-year-old woman with a history of ovarian cancer presents to the
ED with acute onset of right-sided chest pain, shortness of breath, and
dyspnea. Her BP is 131/75 mm Hg, HR is 101 beats per minute, respira-
tions are 18 breaths per minute, and oxygen saturation is 97% on room
air. You suspect this patient has a pulmonary embolism (PE). Which of the
following tests is most likely to be abnormal?
a. Arterial blood gas
b. Oxygen saturation
c. ECG
d. Chest radiograph
e. D-dimer
(Reproduced, with permission, from Tintinalli J, Kelen G, Stapczynski J.Emergency Medicine
A Comprehensive Study Guide. New York, NY: McGraw-Hill, 2004:193)