Step 2

Cardiovascular 9

A 74-year-old man presents to the emergency department at a local community hospital after a mechanical fall causing him to be stuck between the toilet and the wall. He is found to have a creatinine kinase of 1600 and creatinine of 1.3. He is treated appropriately for rhabdomyolysis. He subsequently complains of abdominal pain and some dizziness. A CT scan of the abdomen and pelvis shows marked free air and oral contrast extravasation in the right upper quadrant with the site of perforation appearing to be the duodenum. The patient’s vital signs include a blood pressure of 110/65mmHg, heart rate of 50 beats/minute, and respirations 14/min with an oxygen saturation of 98% on room air. An electrocardiogram (ECG) is performed and is shown below.

Which of the following is the most appropriate next step in management?

  • A) Administer atropine
  • B) Cardiology consultation for ECG interpretation
  • C) General surgery consultation for consideration of emergent laparoscopic surgery
  • D) Start a dopamine drip
  • E) Transfer patient for immediate permanent pacemaker implantation

Authors

Marina Tawadrous

Editor

Dr. Raj Dasgupta

Last updated

Dec 29, 2023

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