Solved

A 70-Year-Old Man Is Brought to the Emergency Department by His

question 58

Multiple Choice

A 70-year-old man is brought to the emergency department by his nephew after being found poorly responsive at home. The patient lives alone and had not been seen for 2 weeks. His family has noticed that he has been confused and less active over the past few months. Medical history is unknown, and family members report only that the patient takes several pills a day for "heart issues," blood pressure, and headaches. Emergency department records show a recent visit for back pain, which was treated with opioid analgesics and centrally acting muscle relaxants.
Temperature is 35 C (95 F) , blood pressure is 120/100 mm Hg, pulse is 55/min, and respirations are 10/min. The patient is lethargic and oriented only to person. He has a puffy face and hands and an enlarged tongue. Pupils are normal and reactive. The neck is supple. Cranial nerve, cardiac, pulmonary, and abdominal examinations are unremarkable. The patient moves all extremities on command.
Laboratory results are as follows:
Chest x-ray shows a mildly enlarged cardiac silhouette and no infiltrates. ECG shows sinus bradycardia, a QTc interval of 450 msec, and T-wave flattening. Additional laboratory testing is pending.
Which of the following is the most appropriate next step in management of this patient?

Definitions:

Organic Product

A molecule that has been produced as a result of an organic reaction, prominently featuring carbon atoms in its structure.

Reaction

A process in which substances, the reactants, are converted into different substances, the products, involving rearrangement of atomic or molecular structures.

Gilman Reagent

Organometallic compounds of the form R2CuLi, utilized in organic chemistry for carbon-carbon bond formation reactions.

3-Methylpentane

An organic compound that is a branched alkane with six carbon atoms, where the methyl group is attached to the third carbon.