Welcome everyone. My name is Divine. This is episode 568 of the Divine Intervention Podcast.

And into this podcast, we're going to finally, finally, finally be finishing up the free 137 step 3 series.

And, you know, we're going to be, this is part 14. It's going to be the final part.

And again, if you're studying for step two, very useful podcast to listen to.

And again, I'm telling you this series is something that, because it's like, hey, why go through 137 questions in a series of podcasts?

But I'm telling you it's very helpful. There is so much

learning, so much integration, and so many test-taking principles have discussed in this series

so far. Again, trust me, it's well worth your while. And if you're even studying for step

three, consider listening to the free 121 on step two as well, where I go through all 120 of the

step two questions. Again, I think it's something that

will be very helpful to your learning process. All right. So question 131, we have a 62 year old male.

He's African American. He's in the emergency room. And it appears he passed out suddenly at

home. So let's look at his HPI. Has collapsed while making breakfast, regain consciousness,

no precipitating factors or symptoms, no one witnessed the fall, but wife heard the fall,

called an ambulance, chest and back pain, penis constant and crushing 10 out of 10. It's not

able to get comfortable. Has a past history of hypertension, He's on a low depine. Doesn't have any drug allergies. Drinks 1 to 2 alcoholic beverages doesn't smoke. We'll look at his vitals. He's tachycordic. His tachycarypnic. His blood pressure is extremely low. 80 over 38. O2sats are a little bit low. BM low BMI's 30 okay now we look at the

physical exam he's visibly uncomfortable um he has shallow breath sounds his tachycardic has a

diastolic murmur um he has a radio pulses at one plus 3d femoraleral pulses. It's not a good situation, right?

ECC shows non-specific ST segment and T-wave changes.

And then we see the CT androgram of the chest.

This is a classic image I would really, really hope you can recognize on your exams.

And then he says, which of the phone is the most appropriate next step in management?

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