Shock

A 63 year old male is admitted to the coronary care unit for thrombolysis following an anterior wall myocardial infarction. Eight hours after admission, and apparent resolution of ischemia, his blood pressure falls precipitously, his pulse rises to 140, his pulse oximeter registers a SpO2 of 88%. On examination, his lung fields are clear, his heart sounds are inaudible and his jugular veins are distended and a pulsation can not be identified.

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