Shock and Resuscitation (1 to 6 of 13 Case studies)
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1) A 67-year-old woman with coronary artery disease had a coronary artery bypass graft surgery 10 years back. Now, she is brought to the emergency with worsening shortness of breath of 2 days duration. For the past 2 days, she has not gotten out to bed and is confused. She does not have chest pain or cough. Her temperature is 98.1 F. Her blood pressure is 85/50 mm Hg, heart rate is 125 beats per minute and respiratory rate is 26 breaths per minute. On examination, she is unable to follow commands and is oriented only to name. The cardiovascular examination reveals tachycardia with no murmur. Her lungs have rales bilaterally at the bases. The abdomen is soft, nontender, and not distended. Lower extremities have 2+ edema bilaterally. What is the diagnosis?
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2)  A 31-year-old man with no past medical problems presents to the emergency with palpitations. For the past 2 days, he has been feeling weak and over the last 6 hours he has noticed that his heart is racing. He has no chest pain or shortness of breath. He has never felt this way before. His temperature is 98.9°F, BP is 140/82 mm Hg, HR is 180 beats per minute, and RR is 14 breaths per minute. His physical examination is normal. The ECG is given below. What is your first-line treatment for this patient? *
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3)  A 21-year-old man was struck by a motor vehicle while crossing the street. In the emergency, he is awake, alert, and oriented, but complaining of severe right-leg pain. His temperature is 98.9°F, BP is 85/50 mm Hg, HR is 125 beats per minute, and RR is 24 breaths per minute. His airway is patent, breath sounds are equal bilaterally, and his abdomen is soft and nontender. His right leg is shorter than his left leg, slightly angulated, and swollen in his anterior thigh area. There is no open wound. What is the most likely diagnosis?
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4) A 70-year-old man is talking incoherently and not eating at his home. He has a past medical history of hypertension, diabetes, dementia, and benign prostatic hypertrophy. On arrival to the hospital, the patient is oriented only to name. His temperature is 101°F rectally, BP is 85/50 mm Hg, HR is 125 beats per minute, RR is 22 breaths per minute, and blood sugar is 154 mg/dL. He appears uncomfortable and cachectic. His lungs are clear to auscultation, with scant crackles at the bases. His abdomen is soft, nontender and not distended. He has a Foley catheter in place draining cloudy, white urine. He has no peripheral edema. What is the most likely diagnosis?
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5) A 73-year-old man is in the emergency for the evaluation of generalized weakness over the previous 24 hours. He has a past medical history of coronary artery disease with a CABG performed 5 years ago, diabetes mellitus, and arthritis. The nurse places the patient on a cardiac monitor and begins to get his vital signs. The patient suddenly becomes unresponsive. You arrive at the bedside and see the rhythm shown below. Which is the next step in management? 
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6) A 29-year-old woman with no known medical problems is having dinner with her husband. Halfway through dinner, she begins scratching her arms and her husband notices that her face is flushed. The itching intensifies and she begins to feel chest pain, shortness of breath, and dizziness. On arrival to the emergency, she can barely talk. Her temperature is 1000 F, BP is 85/50 mm Hg, HR is 125 beats per minute, and RR is 26 breaths per minute, and oxygen saturation is 91% on room air. What is the most likely diagnosis?
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