206.You are caring for a 54-year-old woman with a history of schizo-
phrenia and coronary artery disease who presents to the ED for chest pain.
Her vital signs are within normal limits and her ECG is normal sinus
rhythm with nonspecific ST/T wave changes. Her first troponin is sent to
the laboratory and you are planning to admit her to the hospital for a com-
plete acute coronary syndrome (ACS) evaluation. She receives aspirin and
nitroglycerin and her chest pain resolves. A few minutes later, the nurse
alerts you that the patient has become unconscious. You go to the bedside
and find the patient awake and alert. You review the rhythm strip below.
What is your next step in management?
Shock and Resuscitation 215a. Observe patient
b. Magnesium sulfate IV
c. Lidocaine IV
d. Transvenous pacemaker
e. Isoproterenol IV
207.A 48-year-old man with a medical history of cirrhosis caused by
hepatitis C has been vomiting bright red blood for 1 day. On arrival to the
ED, the patient is confused and unable to provide more information. His
family states that he has been vomiting large amounts of bright red blood
every 4 hours and has no prior history of GI bleeding. The nurses hook him
up to the monitor and start two large-bore IV lines. His BP is 75/43 mm Hg,
HR is 130 beats per minute, RR is 24 breaths per minute, and oxygen sat-
uration is 98% on room air. His abdomen is soft with no masses. His rectal
examination reveals bright red blood. Which type of fluid is most critical in
his resuscitation?
a. 7% Sodium chloride
b. 0.9% Sodium chloride
c. Type and cross-matched blood
d. Type-specific blood
e. Type O, Rh-positive blood