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Old 08-09-2012
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Question managing elderly dizzi patient

A 70-year-old woman is brought by to the emergency room (ER) by her sister after she developed dizziness, nausea, and abdominal pain. She has a history of appendicitis, peptic ulcer disease, and osteoarthritis. Her past surgeries are an appendectomy 50 years ago and an anterior seromyotomy and posterior truncal vagotomy 7 years ago. Her medication is ibuprofen 400 mg, three times per day. Her vital signs are as follows: temperature, 37.9C (100.2F); blood pressure, 80/60 mm Hg; heart rate, 50 beats/minute; and respiration rate, 18 breaths/minute. Pulse oximetry shows 80% oxygen saturation. Oxygen saturation improves to 95% with 40% supplemental oxygen via a nasal cannula. A neck examination shows cannon jugular venous a waves. A chest examination is clear to auscultation and percussion. Cardiac auscultation reveals third and fourth heart sounds heard best at the lower left sternal border that increase in intensity with inspiration. A 12-lead electrocardiograph (ECG) shows increased T-wave width and amplitude in leads II, III, and aVF. A stat portable chest X-ray is ordered. Two large-bore peripheral intravenous (IV) leads are placed, and normal saline (NS) infusion is instituted at 500 mL/hour. What is the most important nonpharmacological next step in patient management?

A. Angiography
B. Echocardiography
C. Hematocrit
D. Right-sided ECG
E. Swan-Ganz catheter placement

plz give your reason along
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