05-04-2007, 02:09 PM
A 31-year-old alcoholic homeless man with a history of type 1 diabetes comes to the urgent care clinic with a left foot ulcer. The ulcer has been present for 4 months, but has been sore for the past 2 weeks. There is no other medical history. His blood pressure is 92/54 mm Hg and pulse is 170/min. Physical examination shows an eschar extending to the bone with necrotic sides on the dorsal aspect of the hallux just distal to the interphalangeal joint. Laboratory studies reveal a leukocyte count of 33,000/mm3. Fingerstick glucose is 210 mg/dL. Urinalysis, complete blood count, chest radiograph, and blood cultures are pending. An electrocardiogram shows a sinus tachycardia at a rate of 180/min. The most appropriate first-line therapy for this patient's tachycardia is
A. atenolol
B. intravenous imipenem
C. intravenous 0.9% normal saline and broad spectrum antibiotics
D. metoprolol
E. packed red blood cell transfusion
A. atenolol
B. intravenous imipenem
C. intravenous 0.9% normal saline and broad spectrum antibiotics
D. metoprolol
E. packed red blood cell transfusion