doyoudig
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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
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| Justice
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Atrial Fibrillation?
Could be (B)
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| arlete
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Never give medication to a patient that is becoming unstable (symptoms, BP=100/50). Beta blocker and calcium channel blocker are going to lower the BP even more; digoxin takes too long to start working.
I'd say it's A because 911 could send an ambulance right away, with a portable cardioversor-defibrillator, it could be needed any time now.
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| doyoudig
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dear arlete pls tell me when we consider a Pt as havin an unstable BP
I know sytolic has to be < 90 but what about distastolic, I am confused ?
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| doyoudig
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ok I think Unstable Bp means < 90/60 = Hypotension
pls confrim
if so than the answer A is correct, call 911 and arrange transport for defib as the doc office is ill equiped for this
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| doc_clotaire
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NSIM of Unstable AF :
E. Make arrangements to have the patient brought to the local emergency department for electrical cardioversion ( look more decent to me than A )
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| doyoudig
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sorry gys i meant answer E sguld be correct then b/c he is hypotensive (if what I said earlier is correct about the Bp Values) , i don't think 911 for assistance is of use, just go ahead n transer him for defib
what do you think??
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| vradojc1
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Yup, go and arrange for Defib
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| young_doc
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i go with E as well..
By the time 911 sends help, patient could have already been in the ER!
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| arlete
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I would be concerned especially with SOB and blood pressure < 90/60 mmHg (even if it's only the diastolic, like in this case). Every time an arrhythmia is causing sudden SOB, the patient is considered unstable.
What makes me think about calling 911 is the possibility of having someone bringing a portable cardiversor/defibrillator for this emergency, and transporting the patient to the ER STAT. "Make arrangements" sounds something very calm, like calling an ambulance, calling the ER ahead to inform a patient is going to need defibrillation, checking with the insurance company, things like that, as if the patient could wait for the arrangements.
But I might be wrong, it depends on how 911 works.
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| webjeee
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then, what is the answer?
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| doyoudig
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sorry guys ans is A...911 1st
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| doc_clotaire
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Explanation please !
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| arlete
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This is a medical emergency. 911 will send people with a portable cardioversosr-defibrillator, which the patient needs ASAP.
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| star1
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A
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