26.A 63-year-old insurance agent is brought to the ED by paramedics for
shortness of breath and a RR of 31 breaths per minute. The patient denies
chest pain, fever, vomiting, or diarrhea. His wife says he ran out of his “water
pill” 1 week ago. His BP is 185/90 mm Hg, HR is 101 beats per minute, oxy-
gen saturation is 90% on room air, and temperature is 98.9°F. There are
crackles midway up both lung fields and 2+ pitting edema midway up his
legs. An ECG shows sinus tachycardia. The patient is sitting up and able to
speak to you. After placing the patient on a monitor and inserting an IV,
which of the following is the most appropriate next step in management?
a. Obtain blood cultures, complete blood cell (CBC) count, and begin empiric
antibiotic therapy.
b. Order a statim (STAT) portable chest x-ray.
c. Administer oxygen via nasal cannula and have the patient chew an aspirin.
d. Administer oxygen via non-rebreather, furosemide, nitroglycerin, and consider
noninvasive respiratory therapy.
e. Rapid sequence endotracheal intubation.
27.A 23-year-old man is brought to the ED after collapsing during a bas-
ketball game. His BP is 80/palp. His father died from a “heart-condition” at
a young age. He is placed on a monitor and the rhythm is shown below.
Which of the following choices best describes this rhythm?
Chest Pain and Cardiac Dysrhythmias 15a. Ventricular fibrillation
b. Atrial fibrillation
c. Wolf-Parkinson-White syndrome
d. Supraventricular tachycardia
e. Torsades de pointes