A -year-old man is brought to the emergency department by ambulance due to severe, heavy chest pressure, diaphoresis, and worsening shortness of breath that began minutes ago. His medical history is significant for chronic obstructive pulmonary disease (COPD), hyperlipidemia, and hypothyroidism. His home medications include a statin, an inhaled fluticasone-salmeterol diskus, and oral levothyroxine.
Upon arrival, his temperature is (), blood pressure is , pulse is , and respirations are . Pulse oximetry is on room air.
Physical examination reveals prominent jugular venous distention while the patient is sitting at a angle. Lung auscultation shows prolonged expiration with mild, scattered wheezes bilaterally, but the lungs are clear of crackles. Cardiac examination reveals tachycardia with a regular rhythm; no murmurs or gallops are appreciated. The liver edge is palpable below the right costal margin.
Laboratory testing shows:
- Troponin I: (Normal )
- TSH: (Normal )
- Free T4: (Normal )
Arterial blood gas on room air reveals a pH of , of , and of .
A -lead electrocardiogram demonstrates ST-segment elevations in leads II, III, and aVF, with reciprocal ST-segment depressions in leads I and aVL.
The patient is given chewable aspirin and an intravenous fluid bolus. Which of the following interventions is most strongly contraindicated in the immediate management of this patient's condition?
- Administration of sublingual nitroglycerinAnswer
- BAdministration of inhaled albuterol and systemic corticosteroids
- CAdministration of empiric ceftriaxone and azithromycin
- DAdministration of intravenous sodium bicarbonate
- EIncreasing the daily dose of levothyroxine