phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
17) A 54-year-old man presents to his physician complaining of intermittent palpitations. The patient reports that, a few times over the past few months, he has had episodes of "pounding in his chest" that are associated with shortness of breath and occasional chest pain. He is forced to sit down if he is standing because of weakness and vertigo. The patient has a history of hypertension and mitral valve prolapse. He takes nifedipine and thiazide daily. While sitting in the office, the patient begins to complain of increasing shortness of breath and palpitations. His blood pressure is 100/50 mm Hg, and his pulse is 110-130/min and irregularly irregular. Which of the following is the most appropriate management at this time?
A. Call 911 for assistance
B. Give the patient an oral dose of a beta blocker
C. Give the patient an oral dose of digoxin
D. Give the patient on oral dose of calcium channel blocker
E. Make arrangements to have the patient brought to the local emergency department for electrical cardioversion
|
| ARJ
Forum Guru
Topics: 133
Posts: 792
|
A. Call 911 for assistance
___________________
"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
It's tough. I'm thinking about ventricular ectopics and atrial fibrillation but can't make up my mind. If it's AF, I'd go with beta blockers, though MVP hasn't been described among the causes of AF as far as I know. Could be a 'lone' case. If it's ventricular ectopics, I thought the treatment was directed at correcting the underlying disease, so among the options I'd pick A, by exclusion(?!)
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
I didn't consider heart blocks as the pulse is too rapid. Answer? Or any other suggestions?
|
| kabu
Forum Senior
Topics: 19
Posts: 105
|
A - I think just for next appropriate mgmt
|
| mani
Forum Guru
Topics: 104
Posts: 1,403
|
A. Call 911 for assistance
___________________
Sincerity and hard work are the keys to success!
|
| DrS
Forum Elite
Topics: 32
Posts: 338
|
I guess the two main possibilities are AF and ventricular ectopics. either way if they are symptomatic beta blockers could be used for both conditions. However as this patient is haemodynamically unstable beta blockers would probably not be a good idea at this stage so I guess it would be A or E? I think I'll finally settle for A
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
It is A
|
| frontal
Forum Guru
Topics: 53
Posts: 421
|
Any reason for the choice, phuluong?
|
| lucky
Forum Guru
Topics: 23
Posts: 505
|
i'd go for B.
i dont understand A, as the patient is in the pysicians office and not in a public place ,why call 911?
|
| phuluong2k
Forum Fanatic
Topics: 714
Posts: 2,008
|
This patient now has atrial fibrillation (AF) with rapid ventricular response (RVR) and is consequently hypotensive. This is a medical emergency. Even the physician caring for this patient is ill equipped to deal with a potentially life-threatening episode of AF with RVR. Activating the system is always appropriate and ensures that trained persons with additional equipment and medications appropriate to an emergency situation will be on hand as soon as possible.
Giving the patient an oral dose of a beta blocker (choice B), digoxin (choice C) or a calcium channel blocker (choice D) is not appropriate for an emergent setting. These medications will take too long to be effective.
Making arrangements to have the patient brought to the local emergency department for electrical cardioversion (choice E) is appropriate ONLY AFTER 911 has been called in the case that the patient needs IMMEDIATE assistance in the office. Without calling 911, the patient may have a seriously adverse event en route to the hospital.
|
|
| |
| | | | | | | | | | | |
Similar forum topics