03-23-2007, 06:09 AM
The correct answer is A.
The patient is hypotensive and bradycardic. This suggests a vagal response, and administering an anticholinergic agent, such as atropine, is the correct treatment.
Inotropic agents, such as dobutamine (choice B), are not indicated at this time, since the patient is hypotensive. If other methods of resuscitation, such as IV hydration, fail, then a pressor is indicated.
A beta blocker, such as metoprolol (choice C), is indicated in the setting of a myocardial infarction, given its cardioprotective effect. In this acute setting, however, its effect on the pulse and blood pressure will be counter-productive.
If the bradyarrhythmia and hypotension persist after the administration of atropine, the insertion of a temporary pacemaker is indicated (choice D). If the patient develops a sick sinus syndrome as a result of the infarct, and is symptomatic in terms of hypotension and syncope, then a pacemaker may be needed.
Cardiac catheterization is indicated in the acute setting (choice E). In this patient, 8 hours have elapsed, and his ST segments have resolved. If he develops another ST segment elevation myocardial infarction, then he will need an emergent catheterization.
The patient is hypotensive and bradycardic. This suggests a vagal response, and administering an anticholinergic agent, such as atropine, is the correct treatment.
Inotropic agents, such as dobutamine (choice B), are not indicated at this time, since the patient is hypotensive. If other methods of resuscitation, such as IV hydration, fail, then a pressor is indicated.
A beta blocker, such as metoprolol (choice C), is indicated in the setting of a myocardial infarction, given its cardioprotective effect. In this acute setting, however, its effect on the pulse and blood pressure will be counter-productive.
If the bradyarrhythmia and hypotension persist after the administration of atropine, the insertion of a temporary pacemaker is indicated (choice D). If the patient develops a sick sinus syndrome as a result of the infarct, and is symptomatic in terms of hypotension and syncope, then a pacemaker may be needed.
Cardiac catheterization is indicated in the acute setting (choice E). In this patient, 8 hours have elapsed, and his ST segments have resolved. If he develops another ST segment elevation myocardial infarction, then he will need an emergent catheterization.
