This patient presents with chest pressure at rest and an anterior ST segment elevation myocardial infraction (STEMI) seen on 12-lead EKG. This patient should be given aspirin, IV fluids to increase the preload status, and receive immediate coronary reperfusion therapy. This patient’s hypotension is likely due to infarction of the left ventricle causing poor cardiac output (Choice D). This is known as cardiogenic shock. The patient has been vomiting, but the acute onset of symptoms and STEMI on EKG make poor cardiac output (Choice D) more likely than hypovolemia (Choice A) as the cause for the patient’s condition. Systemic infection (Choice B) and pulmonary embolism (Choice C) are also less likely given the clinical information in the case and the STEMI on EKG. The best answer is Choice D. Please see the chart below for further detailing of the different types of shock.
Cite this article as: Joseph Ciano, USA, "Question Of The Day #55," in International Emergency Medicine Education Project, September 17, 2021, https://iem-student.org/2021/09/17/question-of-the-day-55/, date accessed: March 24, 2023
Joey Ciano, DO, MPH is an Emergency Medicine Physician from New York, USA. He completed his Emergency Medicine Residency in Brooklyn, NY and a Fellowship in Global Emergency Medicine in the Northwell-LIJ Health System. He is interested in building the educational infrastructure of EM in countries where EM is not yet recognized as a field and in countries that are in the early stages of this process. He has partnered with international NGOs in EM educational projects and works as a visiting EM faculty member in West Bengal, India. He is excited to collaborate with the other authors of the iEM Education Project to contribute to world of FOAM-ed.
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