Answer and Explanation 2

2.  The answer is C.  This patients clinical picture is concerning for a pulmonary embolus.  He is tachycardic and hypoxic with a normal chest x ray and lung exam.  While tachycardic arrhythmia’s  can cause dyspnea, they usually do not cause hypoxia.  Choice A is not the best answer.  While it is true a small percentage of patients with bronchospasm can present with a normal lung exam, the patients tachycardia could be exacerbated by giving a patient a Beta 2 agonist Albuterol.  It would be unusual for the patient to have that significant of hypoxia and bronchospasm with normal lung sounds and chest x ray.  Choice B giving the patient metoprolol is not a good idea because the patients tachycardia is being caused by the patients hypoxemia.  It is possible to actually induce bronchospasm giving the patient beta blockers.  Choice D giving the patient cardizem would slow the patient’s heart rate down and not really be beneficial.