A 68-year-old man is brought by ambulance to the emergency department of a PCI-capable hospital after 4 hours of crushing central chest pressure and diaphoresis. He has hypertension, type 2 diabetes and a 40 pack-year smoking history, and takes ramipril and metformin; he has no known drug allergies. He is drowsy but answers questions, and on examination his extremities are cool and mottled, his jugular venous pressure is elevated and there are bibasilar crackles. ECG shows ST-segment elevation in leads V1 to V4. Point-of-care ultrasound shows severely reduced left ventricular systolic function, a plethoric inferior vena cava and no pericardial effusion. Lactate is 4.8 mmol/L (0.5-2.0).
| Heart rate | 112/min |
| Respiratory rate | 28/min |
| Temperature | 36.5 °C |
| O2 saturation | 88%, room air |
| Blood pressure | 78/56 mm Hg |
Question 1 of 9
Oxygen is started and the patient remains hypotensive. Which of the following are the most appropriate medications for hemodynamic support at this time?
Select 2. (0 / 2 selected)
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