4.4 of 12 Ratings
An 86-year-old man with a history of COPD, hypertension, and diabetes presents to the emergency department with dyspnea and palpitations. He states his symptoms started 1 hour ago and have persisted. His temperature is 100.0°F (37.8°C), blood pressure is 157/98 mm Hg, pulse is 130/min, respirations are 23/min, and oxygen saturation is 90% on room air. Physical exam is notable for digital clubbing, bilateral wheezing, and an obese abdomen. An ECG is performed as seen in Figure A. The patient is given continuous albuterol-ipratropium nebulizers with minimal improvement. Which of the following is the best next step in management?
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