![]() Before the cardiologist arrives in the ED, the patient's ECG has returned to normal. An ECG, however, shows 2mm ST-segment elevation and inverted T waves in leads V1 through V5 and 1mm ST-segment depression in leads II, III, and aVF. The ED physician is initially dubious that the pain is cardiac in origin, because the woman has no coronary disease risk factors. The pain is midsternal and is described as pressure that extends as a band around her chest. She has had such episodes intermittently over the last 5 years, usually when sleeping, but over the last year she has had more frequent severe symptoms that are occasionally associated with severe migraine headaches. Which of the following interventions is the most appropriate treatment? - Atropine - Charcoal - Glucagon - Naloxone - PralidoximeĪ 35-year-old woman comes to the ED complaining of chest pressure. Pupils are miotic and the child has diffuse muscle weakness. Auscultation of the lungs reveals a diffuse wheeze bilaterally. Her BP is 88/48 mmHg, pulse is 90/min, RR 33/min, Temp 38 C. None of the family members was wearing any protecting clothing. On direct questionning, the parents admit that the child was assisting with spraying crops with pesticides the previous day. The parents originally were worried about bringing the child to the ED because they feared deportation since the family are illegal immigrants employed to pick strawberries on a nearby farm. Further discussion with the child indicates that she suffers from blurred vision and headache. For the last 12 hours, the child has suffered severe nausea and vomiting, as well as diarrhoea and abdominal cramps. The parents of a 9-year-old girl bring their daughter to the ED. Which of the following is the most appropriate next step in management? - Coronary angiography - Holter monitor - No further tests are required - Repeat stress test with thallium - Upper gastrointestinal endoscopy The ST segment depression is greater than 0.12 seconds in duration and the stress test is stopped. Five minutes into the test, he develops ST depression of 3mm in leads V1-V5. Cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. On physical examination, his blood pressure is 150/80 mmHg and heart rate is 86/min. There is a family history of heart disease, and his father died of a heart attack at age 48. He believes these episodes are due to indigestion and has been taking antacids. The pain is sharp in nature, mainly over his lower chest and epigastrium, and tends to come on when walking. He complains of several episodes of chest pain in the past few months. The patient's job involves a lot of travelling, and he admits to occasionally forgetting to take his medications with him when he travels. A 46-year-old man with a history of hypertension and hypercholesterolemia visits the physician for a routine followup.
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