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4. 1 and 3
The ECG shows atrial flutter with 2:1 block. Since an operation is planned shortly, correction to normal sinus rhythm would be ideal and cardioversion is the quickest way to accomplish this. However, not until a TEE is performed to ensure that no clot is present in the heart which could be released with cardioversion.
A TEE was performed which revealed no potential thrombi. Cardioversion successfully converted the patient to normal sinus rhythm with resolution of her symptoms.
Cardiac surgery recommended a pericardiectomy which was performed. Thick calcified pericardium containing chalk-like fluid was found. She returned to the ICU in stable condition. However, approximately 1 hour after returning to the ICU the patient became more unstable with tachycardia, hypotension, and worsening urine output.
Which of the following should be done? (Click on the correct answer to proceed to the fifth of seven pages)