203.An 82-year-old man presents to the ED feeling weak and dizzy. He
has a past medical history of hypertension and diabetes and both are well
controlled on hydrochlorothiazide, benazepril, atenolol, and metformin.
On review of systems, he denies chest pain, gastrointestinal (GI) bleeding,
and syncope, but states that he feels short of breath. His temperature is
98.6°F orally, BP is 86/60 mm Hg, HR is 44 beats per minute, RR is 18 breaths
per minute, oxygen saturation is 98% on room air, and glucose is 116 mg/dL.
He is immediately connected to the cardiac monitor. Which of the following
choices best describes the ECG seen below?
Shock and Resuscitation 213a. Normal sinus rhythm
b. First-degree AV block
c. Second-degree Mobitz I (Wenckebach) AV block
d. Second-degree Mobitz II AV block
e. Third-degree AV block
204.A 25-year-old man fell off his surfboard and landed on rocks. He was
pulled from the water by lifeguards and brought to the ED in full cervical and
spinal immobilization. He is alert and oriented to person, place, and time. He
is complaining of weakness in all of his extremities. His temperature is
98.4°F, BP is 85/50 mm Hg, HR is 60 beats per minute, RR is 20 breaths per
minute, and oxygen saturation is 98% on room air. On examination, he has
no external signs of head injury. His heart is bradycardic without murmurs.
The lungs are clear to auscultation and the abdomen is soft and nontender.
He has grossly normal peripheral sensation, but no motor strength in all
four extremities. Which of the following is the most likely diagnosis?
a. Hypovolemic shock
b. Neurogenic shock
c. Cardiogenic shock
d. Anaphylactic shock
e. Septic shock