drdg
Forum Senior
Topics: 31
Posts: 176
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A 65-year-old woman with a prior history of MI 8 months ago presents to the ER via with shortness of breath. For the past 2 hours she has experienced dyspnea at rest and has been coughing up sputum. She denies chest pain. She is a 35-pack-year smoker and drinks 20 units of alcohol a week. PE shows she is in distress and breathing 60% through a facemark. She is unable to complete full sentence. Whils examing the patient, she coughs up sputum. The sputum is bloodstained. There is evidence of JVD and pedal edema. There is no chest wall tenderness, however, auscultation reveals fine crepitations throughout the chest. There are no murmurs or rubs. Her ECG is consistent with atrial fibrillation. What is the next best step in management?
A. Dobutamine
B. Dopamine
C. Echocardiography
D. Hydralazine
E. IV loop diuretic, nitrates and morphine
F. MUGA scan
G. Synchronized cardioversion
H. Verapamil
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| neuroblastoma
Forum Guru
Topics: 99
Posts: 1,010
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complications of MI---pulmn edema and atrial fibrillation
i would go for MUGA scan.
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| neuroblastoma
Forum Guru
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??WHTS answer here??
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
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G - before she dies!!!! She's in an acute pulmonary edema, probably due to atrial fibrillation onset, 2 hours ago. Therefore she has an arrhythmia with unstable clinic presentation. Never order tests in these cases, you'll waste time.
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| darkhorse
Forum Elite
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Posts: 275
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synchronised cardioversion
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| Kamsi
Forum Guru
Topics: 103
Posts: 347
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G
This patient has COPD ( hx of smoking,cough with sputum, in distress,SOB n is progressing to corpulmonale with edema n raised JVP) exacerbated by atrial fibrillation.I"m btw verapamil n cardioversion since she's unstable do conversion
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
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Never give verapamil to an unstable patient. 
You are right. 
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| drdg
Forum Senior
Topics: 31
Posts: 176
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The answer is G
The explanation exact likes arlete wrote:
G - before she dies!!!! She's in an acute pulmonary edema, probably due to atrial fibrillation onset, 2 hours ago. Therefore she has an arrhythmia with unstable clinic presentation. Never order tests in these cases, you'll waste time.
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