A 64-year-old woman is brought to the emergency department due to fever, chills, flank pain, and lethargy for the past 2 days.  Temperature is 38.9 C (102 F), blood pressure is 100/60 mm Hg, and pulse is 120/min.  The patient has right costovertebral angle tenderness.  Leukocytes are 16,000/mm3 and urinalysis shows pyuria, many bacteria, and positive nitrites.  ECG shows sinus tachycardia.  A central venous catheter placement is planned for intravenous therapy and hemodynamic monitoring.  After the patient's chest is appropriately prepared and draped, a needle is inserted just lateral to the angle of the left clavicle and a triple lumen catheter is placed into the left subclavian vein.  Each lumen is flushed with sterile saline after obtaining blood return.  The catheter is sutured in place to the skin and a sterile dressing is applied.  Which of the following is the best next step in management of this patient?

A 75-year-old man is brought to the emergency department from home after being found unresponsive by his son.  His medical history is significant for coronary artery disease with coronary stenting 2 years ago, diabetes mellitus, hypertension, and stroke.  He was hospitalized 2 months ago with pneumonia and upper gastrointestinal bleeding, during which time he received intravenous antibiotics and a transfusion of 4 units of packed red blood cells.  In the emergency department today, temperature is 39.1 C (102.4 F), blood pressure is 70/40 mm Hg, pulse is 120/min, respiratory rate is 32/min, and oxygen saturation is 79% on room air.  Laboratory results are notable for leukocytosis but are otherwise unremarkable.  Chest x-ray reveals a new right upper lobe infiltrate.  He is treated with normal saline, antibiotics, vasopressors, and mechanical ventilation.  The next day, laboratory analyses reveal the following:Hemoglobin 9.5 mg/dLLeukocytes 15,000/mm3Platelet 120,000/mm3Sodium 137 mEq/LPotassium 4.1 mEq/LChloride 100 mEq/LBicarbonate 19 mEq/LBlood urea nitrogen 51 mg/dLCreatinine 2.1 mg/dLBilirubin, total 1.2 mg/dLAspartate aminotransferase 3,720 units/LAlanine aminotransferase 3,250 units/LAlkaline phosphatase 162 mEq/LWhich of the following most likely accounts for the abnormal liver function panel? A.Acute viral hepatitis B.Alcoholic liver disease C.Granulomatous liver disease D.Ischemic hepatic injury E.Acalculous cholecystitis F.Iron overload G.Autoimmune hepatitis

A 66-year-old man comes to the emergency department with significant pain in the right leg.  He says, "The pain started yesterday; I tried resting and taking acetaminophen, but it did not go away."  Medical history includes coronary artery disease with a previous anterior wall myocardial infarction, heart failure with reduced ejection fraction, hypertension, and hyperlipidemia.  The patient does not adhere regularly to prescribed medications.  He does not smoke cigarettes or consume alcohol.  The patient appears to be in moderate discomfort due to pain.  Temperature is 36.7 C (98.1 F), blood pressure is 150/90 mm Hg, pulse is 102/min and regular, and respirations are 14/min.  On physical examination, the right lower extremity appears pale and cooler than the left.  On palpation, no pulses can be appreciated at the right popliteal and dorsalis pedis arteries, but they are detected on Doppler examination.  Sensory and motor examination is unremarkable.  Intravenous heparin infusion is initiated.  Which of the following is the best next step in management of this patient?

A 17-year-old female is referred to the ED by her primary physician; she presents with a 3-day history of fevers, dysuria, and vomiting. She has not had vaginal discharge, abdominal pain, or diarrhea. She is sexually active with her partner. Vital signs are as follows: Temperature 103°F, RR 20, BP 98/65, pulse 100. She appears ill and is unable to tolerate liquids, but she is alert and oriented. Her examination is positive for suprapubic as well as costovertebral angle tenderness bilaterally. Urinalysis reveals numerous WBCs and bacteria, and it is positive for WBC casts and leukocyte esterase. Other laboratory study results are within normal limits, including a negative urine pregnancy test. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesNephrolithiasisPyelonephritisAppendicitisAcute interstitial nephritisEctopic pregnancy

A 58-year-old man comes to the emergency department due to sudden onset of severe right leg pain several hours ago; the leg has since become numb.  He has never had similar symptoms and has no history of trauma, fever, or chills.  The patient recently had an acute anterior wall myocardial infarction that resulted in cardiogenic shock; he is undergoing cardiac rehabilitation.  Temperature is 36.7 C (98.1 F), blood pressure is 120/70 mm Hg, pulse is 90/min and regular, and respirations are 16/min.  Cardiopulmonary examination is unremarkable.  Compared with the left leg, the right leg appears pale and is cool to the touch.  In the right lower extremity, the popliteal pulse is normal, but more distal pulses are not palpable.  Pulses in the other extremities are normal.  Neurologic examination shows loss of sensation over the dorsum of the right foot and mild weakness with dorsiflexion.  Which of the following is the most likely cause of this patient's symptoms?

A 35-year-old male arrives to the emergency room with multiple long bone fractures and an internal abdominal injury. The patient is anxious. Patient's vital signs are: Blood pressure 70/54, heart rate 125 bpm, respirations 30, oxygen saturation on 2 L nasal cannula 96%, temperature 99.3 'F, pain 6 on 1-10 scale. During assessment it is noted the skin is cool and clammy. The nurse will make it priority to?Question 7Select one:a.Establish 2 large-bore IV access sitesb.Obtain an EKGc.Place a warming blanket on the patientd.Collect a urine sample