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4. 1 and 3
She has constrictive pericarditis due to chronic inflammation of her pericardium resulting in poor ventricular filling and congestive heart failure. Improvement will likely require a pericardiectomy performed by cardiac surgery. Diuresis is indicated because of her fluid overload at the present time but should not be excessive because of her likely upcoming pericardiectomy. Although the health benefits of tight-control of diabetes are debatable, achieving a blood sugar below 110 mg/dL is probably not advisable just before a planned operation because of the risk of hypoglycemia (1).
While awaiting thoracic surgery consult the patient suddenly develops a rapid pulse and becomes increasingly short of breath. An ECG is performed (Figure 1).
Figure 1. ECG performed after sudden onset of shortness of breath.
Which should be done at this time? (Click on the correct answer to proceed to the fourth of seven pages)