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December 2010, Volume 40 Number 12 , p 72 - 72


  • Karen Jean Craig BS, RN


ACCOMPANIED BY her daughter, Marge Brown, 68, arrives at your ED complaining of general weakness and feeling like she's going to faint. She's alert and oriented, but her skin is pale, cool, and diaphoretic. She denies shortness of breath or chest discomfort. Her vital signs are temperature, 98.8[degrees] F oral (37.1[degrees] C); pulse, 40 and regular; respirations, 24; SpO2, 93% on room air; and BP, 80/60.Mrs. Brown tells you she thought she just had the flu, but after she had a near-syncopal episode at home, her daughter insisted she seek medical attention. She has a history of dyslipidemia and prediabetes, but both are diet-controlled. Mrs. Brown takes a daily multivitamin but no prescription medicines.Based on Mrs. Brown's targeted history and physical assessment findings, you suspect symptomatic bradycardia, defined as a heart rate less than 60 with signs and symptoms of poor perfusion caused by the slow heart rate. These signs and symptoms include acute altered mental status, ongoing

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