A 54-Year-Old Man Comes to the Emergency Department After an Episode

question 635

Multiple Choice

A 54-year-old man comes to the emergency department after an episode of syncope.  While he was watching television 30 minutes ago, he experienced sudden-onset chest pressure followed by a syncopal episode.  He regained consciousness within a minute but continues to have chest "heaviness" and shortness of breath.  Two days ago, the patient returned home from an extended car trip.  He has a history of hypertension, osteoarthritis, and prostate cancer treated with brachytherapy.  He is a former smoker with a 15-pack-year history and does not use alcohol or illicit drugs.  Temperature is 38.3 C (100.9 F) , blood pressure is 81/50 mm Hg, pulse is 110/min and regular, respirations are 26/min, and pulse oximetry is 92% on room air.  The lungs are clear to auscultation.  Cardiac examination shows a nondisplaced point of maximal impulse, with no murmurs but an accentuated pulmonic component of S2.  Laboratory results are as follows:
ECG shows sinus tachycardia with nonspecific ST-segment and T-wave changes.  CT angiography reveals filling defects in the bilateral main pulmonary arteries.  Blood pressure after multiple fluid boluses is 85/60 mm Hg and pulse is 108/min.
The patient develops progressive hypoxemia requiring 100% supplemental oxygen via a nonrebreather mask, but even with treatment his respiratory distress worsens and he becomes progressively confused and lethargic.  Endotracheal intubation is performed and mechanical ventilation is initiated.  Intravenous norepinephrine infusion is started due to persistent hypotension.  Bedside echocardiography reveals right ventricular dilation and hypokinesis, but left ventricular contractility is normal.  Which of the following is the best next step in management of this patient?

• A)Administer thrombolytic therapy
• B)Begin milrinone to improve right ventricular function
• C)Initiate intravenous heparin infusion
• D)Perform low tidal volume ventilation
• E)Place a retrievable inferior vena cava filter

Differentiate between technical design and social design.

Identify key players in the building design process and their roles.

Recognize the importance of matching architectural design with user needs and expectations (alpha and beta matching).

Describe the major goals of social design and how they influence behavior and user satisfaction.

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Definitions:

Low-Wage Countries

Nations with a general level of income that is much lower than the global average, often associated with high levels of poverty.

Neoclassical Economists

Economists who follow the neoclassical school of thought, focusing on supply and demand as drivers of price, output, and allocation of resources in markets.

Free Markets

Economic systems in which prices for goods and services are determined by the open market and by consumers, with minimal governmental intervention or regulation.

Global Economy

The international network of economies and markets, interconnected and influenced by global trade, investment, and information technology.