On examination, the patient is now awake and alert but oriented only to person. His blood pressure is 120/70 mm Hg, pulse is 65/min, and respirations are 14/min. Laboratory tests ordered 30 minutes before the first event are shown below.
Serum chemistry Sodium Potassium Chloride Bicarbonate Blood urea nitrogen Creatinine Calcium Blood glucose Magnesium Phosphorus
144 mEq/L 4.5 mEq/L 108 mEq/L 20 mEq/L 20 mg/dl 1.1 mg/dl 9.6 mg/dl 240 mg/dl 1.8 mg/dl 3.5 mg/dl
Which of the following is the most appropriate next step in management of this patient?
- A. Intravenous amiodarone r
- B. Intravenous lidocaine r
- C. Intravenous magnesium sulfate r
- D. Oral metoprolol r
- E. Temporary transvenous pacing
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A 46-year-old man with type 2 diabetes mellitus is scheduled for cardiac catheterization in 2 days for undiagnosed, episodic chest pain. For 15 days, the patient has had retrosternal chest pain radiating to his arm, and it is becoming more frequent. He went to the emergency department 7 days ago due to chest pain. The patient was admitted for overnight observation but left against medical advice. Three se ts of cardiac enzymes tests were negative, and his electrocardiogram showed nonspecific ST-T changes. He has a history of hypertension, a 6-year history of diabetes mellitus, and does not check his blood glucose levels regularly. The patient’s medications include metformin and lisinopril. At his last emergency department visit, laboratory results (chemistry profile and comple te blood count) were normal, and he was started on low-dose aspirin. He has a long smoking history, and uses alcohol occasionally. The patient has a strong family history of premature coronary artery disease. Today, blood pressure is 136/70 mm Hg and pulse is 66/min. His body mass index is 30 kg/m2. The remainder of the examination is within normal limits. Which of the following is the best next step in management of this patient?
- A. Continue current medications throughout procedure r
- B. Discontinue aspirin r
- C. Discontinue lisinopril now and restart 2 days after procedure r
- D. Discontinue metformin on day of procedure and restart 2 days after procedure r
- E. Start amlodipine
0 voters