Rationale: Hypotension is commonly associated with right ventricular infarctions (secondary to parasympathetic stimulation and a decrease in left ventricular filling.) Therefore one goal of treatment for right sided infarctions is an increase in the patientвЂ™s blood pressure. Although back pain may be associated with endometriosis, radiation to the left or right scapula is not common (radiation of pain to the scapula is more commonly associated with cholecystitis). Foul smelling brown-colored vaginal discharge is more likely associated with a vaginal infection rather than endometriosis. Vaginal bleeding, as opposed to amenorrhea is associated with endometriosis and fevers are not a common finding with this condition. Rationale: Endometriosis frequently causes dysfunctional uterine bleeding (bleeding outside of menstruation.) This bleeding is often accompanied by abdominal or back pain and is often exacerbated by activities such as sexual intercourse (dyspareunia).

A carbon dioxide level of 44 mm Hg is within normal limits which is consistent with a metabolic acidosis.

Serum bicarbonate is normally 22 to 26 mEq/L, metabolic acidosis causes serum bicarbonate to decrease below normal. A serum bicarbonate level of 16 mEq/L further validates a metabolic acidosis. A serum pH of 7.30 is normal, and a serum pH of 7.43 ad 7.51 indicate alkalosis instead of acidosis. Acidosis is marked by a serum pH below 7.35 (for example, a serum pH of 7.26). A decreased cardiac output will cause metabolic acidosis because of decreased oxygen delivery to the tissue. Rationale: A pericardial tamponade, caused by a restrictive pericarditis, will decrease cardiac output. Rationale: The dose of phenytoin sodium (Dilantin) is not to exceed 50 mg/minute in the adult (and 25 mg/minute in the elderly because of decreased renal clearance.) Higher doses can cause toxicities which can lead to depression of the heart rate and contractility and unwanted drops in the blood pressure. The peak effect of this drug occurs approximately 30 вЂ“ 90 minutes after administration and the duration of action is 4 вЂ“ 5 hours. Rationale: The analgesic effects of hydromorphone (Dilaudid) take approximately 15 вЂ“ 30 minutes to begin. This would cause symptoms such as hypertension (rather than hypotension), tachycardia (rather than bradycardia), tachypnea, diaphoretic skin, elevated temperatures, mydriasis (rather than miosis) and agitation. Rationale: Lysergic acid diethylamide (LSD) is a sympathomimetic drug and causes stimulation of the sympathetic nervous system. Failure of the pacemaker battery is more likely to cause the pacemaker to fail to pace (demonstrating pacing spikes not followed by QRS complexes) or to fail to sense (pacing spikes in or after QRS complexes). Increased pacemaker output is not generally associated with implanted pacemakers and would not show changes on the electrocardiogram. An exit block would appear as pacing spikes on the electrocardiogram without QRS complexes following the spikes. Rationale: Artifact at the baseline on the electrocardiogram of a patient with an implanted pacemaker is most commonly associated with external electrical interference such as electrocautery or magnetic resonance imaging. The decrease in respiratory rate and effort associated with myxedema coma is more likely to cause a respiratory acidosis rather than alkalosis. Bradycardia, rather than tachycardia and hypoglycemia rather than hyperglycemia are associated with the decreased metabolic states of myxedema coma. Decreased metabolism will cause a drop in core body temperature but the decrease in metabolism also suppresses shivering. Rationale: Myxedema coma is caused by decreased thyroid levels which decreases metabolism.

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