====== Problems for Discussion - 2 - Vasodilators ======

===== PROBLEM 1 =====

A 65-year-old male is brought by ambulance to the Emergency Department with prolonged chest pain, which began during intercourse. Initially, he was awake and alert with a pulse rate of 110/min and a blood pressure of 160/100. The ambulance paramedic gave him aspirin 150 mg and one sublingual glyceryl trinitrate 5 minutes before arrival in the ED. His blood pressure is now 70 systolic with a heart rate of 120/min. He is drowsy but rousable and is still complaining of chest pain. His regular medications are aspirin, pravastatin, isosorbide mononitrate and anginine, which he takes 2-3 times a week. An ECG shows sinus tachycardia and lateral ST depression.

  - What specific questions do you need to ask the patient?
  - What are the possible causes of his hypotension?
  - Assuming that glyceryl trinitrate precipitates his hypotension how should you proceed with management?

===== PROBLEM 2 =====

A 3-year-old is brought to hospital after ingesting one of his grandmother’s enalapril tablet 30 minutes ago. The child will not drink charcoal.

  - How will you decontaminate this child?
  - What is the expected clinical course?
  - What management is likely to be needed?

===== PROBLEM 3 =====

A 56-year-old male with a history of hypertension and ischaemic heart disease presents after ingesting 30 300 mg irbesartan tablets with alcohol 2 hours previously. He is drowsy but rousable and orientated. HR is 90/min and BP 160/95.

  - What further assessment is required?
  - What is the expected clinical course?
  - What is the patient’s prognosis?