A 42-yeаr-оld mаn cоmes tо the emergency depаrtment complaining of chest pain. He states that he was at the grocery store when he developed severe, burning chest pain along with palpitations and nausea. He screamed for someone to call an ambulance. He says this has happened before, including at least 4 episodes in the past month that were all in different locations including once at home. He is worried that it could happen at work and affect his employment status. He has no significant past medical history, and reports that he does not like taking medications. He has had trouble in the past with compliance due to side effects. The patient’s temperature is 98.9°F (37.2°C), blood pressure is 133/74 mmHg, pulse is 110/min, and respirations are 20/min with an oxygen saturation of 99% on room air. On physical examination, the patient is tremulous and diaphoretic. He continually asks to be put on oxygen and something for his pain. An electrocardiogram is obtained that shows tachycardia. Initial troponin level is negative. A urine drug screen is negative. Thyroid stimulating hormone and free T4 levels are normal. Which of the following is first line therapy for the patient for long-term management?
A 24-yeаr-оld wоmаn presents tо her primаry care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, has difficulty with concentration, and has trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father suffers from major depressive disorder. Her temperature is 99°F (37.2°C), blood pressure is 127/98 mmHg, pulse is 55/min, and respirations are 13/min. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?
A 16-yeаr-оld femаle is brоught tо the emergency depаrtment by her family after discovering her unresponsive. The patient had locked herself in her room for several hours after breaking up with her boyfriend. When her family found her, they were unable to arouse her and immediately took her to the hospital. The patient has a past medical history of anorexia nervosa, which is being treated, chronic pain, and depression. She is not currently taking any medications. The patient has a family history of depression in her mother and grandmother. IV fluids are started, and the patient seems to be less somnolent. Her temperature is 101°F (38.3°C), pulse is 112/min, blood pressure is 90/60 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. On physical exam, the patient is somnolent and has dilated pupils and demonstrates clonus. She has dry skin and an ultrasound of her bladder reveals 650 mL of urine. The patient is appropriately treated with sodium bicarbonate. Which of the following is the best indicator of the extent of this patient's toxicity?