13.A 55-year-old man presents to the ED with worsening weakness, muscle
cramps, and paresthesias. His past medical history is significant for hyperten-
sion and diabetes. He smokes one pack of cigarettes per day. On examination,
the patient is alert and oriented and diffusely weak. An ECG is seen below.
Which of the following is the most important next step in management?
Chest Pain and Cardiac Dysrhythmias 9a. Administer calcium gluconate.
b. Administer insulin and dextrose.
c. Administer aspirin and call the catheterization laboratory.
d. Order an emergent head CT scan and get a neurology consult.
e. Collect a sample of his urine to test for ketones.
14.While eating dinner, a 55-year-old man suddenly feels a piece of steak
“get stuck” in his stomach. In the ED, he complains of dysphagia, is drool-
ing, and occasionally retches. On examination, his BP is 130/80 mm Hg,
HR is 75 beats per minute, RR is 15 breaths per minute, and oxygen satu-
ration is 99% on room air. He appears in no respiratory distress. Chest x-ray
is negative for air under the diaphragm. Which of the following is the most
appropriate next step in management?
a. Administer 1-mg glucagon intravenously while arranging for endoscopy.
b. Administer a meat tenderizer such as papain to soften the food bolus.
c. Administer 10-mL syrup of ipecac to induce vomiting and dislodge the food
bolus.
d. Perform the Heimlich maneuver until the food dislodges.
e. Call surgery consult to prepare for laparotomy.