76.A 79-year-old man was being commemorated at an awards dinner for
his 50 years of service at the local bank. While eating a steak dinner, he felt
food get stuck in his stomach. He drank a glass of water, but shortly there-
after vomited the water up. He is a bit anxious and decides to come to the
ED for further evaluation. His BP is 155/70 mm Hg, HR is 98 beats per
minute, RR is 18 breaths per minute, and oxygen saturation is 99% on
room air. What is the most common area for an esophageal foreign body to
lodge in an adult?
a. Aortic arch
b. Cricopharyngeus muscle
c. Tracheal bifurcation
d. Lower esophageal sphincter
e. Pyloric sphincter
77.A 49-year-old man presents to the ED with nausea, vomiting, and
abdominal pain that began approximately 2 days ago. The patient states that
he usually drinks a six-pack of beer daily, but increased his drinking to two
six-packs daily over the last week because of pressures at work. He notes
decreased appetite over the last 3 days and states he has not had anything to
eat in 2 days. His BP is 125/75 mm Hg, HR is 105 beats per minute, and RR
is 20 breaths per minute. You note generalized abdominal tenderness on
examination. Laboratory results reveal the following:
White blood cells (WBC) 9000/μL Sodium 131 mEq/L
Hematocrit 48% Potassium 3.5 mEq/L
Platelets 210/μL Chloride 101 mEq/L
Aspartate transaminase (AST) 85 U/L Bicarbonate 10 mEq/L
Alanine transaminase (ALT) 60 U/L Blood urea nitrogen
(BUN) 9 mg/dL
Alkaline phosphatase 75 U/L Creatinine 0.5 mg/dL
Total bilirubin 0.5 mg/dL Glucose 190 mg/dL
Lipase 40 IU Nitroprusside test weakly
positive for ketonesWhich of the following is the mainstay of therapy for patients with this
condition?
a. Normal saline (NS) solution
b. Half normal saline (^1 / 2 NS)
c. Glucose solution (D5W)
d. Solution containing both saline and glucose (D 5 /NS or D 51 / 2 NS)
e. The type of solution is irrelevant
78 Emergency Medicine