of fatigue and shortness of breath. She states that she often has similar symptoms, but they usually are “not like this” and pass in a day. The woman has been considerably more fatigued lately with increased stress over family finances and complains of chest pain “on and off all day” last week. She felt so poor she spent most of that day in bed.
Your patient is a former smoker of 12 years (she quit 10 years ago when diagnosed with diabetes), and takes her PO anti-hyperglycemic and anti-hypertensive medications “on most days”.
In the ED, she is uncomfortable in moderate respiratory distress. She has wheezes throughout both lung fields, her pulse is elevated, and her skin is pale. She has no
murmur and her monitor shows no acute changes.
You are called away unexpectedly from the bedside briefly and when you return, your
patient appears worse. Vital signs are repeated immediately to show a HR of 128, BP 85/60, RR 24, SpO2 93% on ambient air. She is in respiratory distress and her neck veins appear full. A transthoracic probe is technically difficult due to her hyperinflated lungs from chronic disease.
Which of the following is the MOST LIKELY cause of her shock?
A. Acute myocardial infarction
B. Myocardial wall rupture
In the meantime, a quote –
“The value of experience is not in seeing much, but in seeing wisely.”
– William Osler