Soru

A $65$-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 $90$ 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 $37.0^\circ\text{C}$ ($98.6^\circ\text{F}$), blood pressure is $86/52\text{ mm Hg}$, pulse is $108/\text{min}$, and respirations are $24/\text{min}$. Pulse oximetry is $92\%$ on room air.

Physical examination reveals prominent jugular venous distention while the patient is sitting at a $45^\circ$ 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 $4\text{ cm}$ below the right costal margin.

Laboratory testing shows:
- Troponin I: $2.4\text{ ng/mL}$ (Normal $<0.04\text{ ng/mL}$)
- TSH: $5.5\text{ \mu U/mL}$ (Normal $0.4 - 4.0\text{ \mu U/mL}$)
- Free T4: $1.1\text{ ng/dL}$ (Normal $0.8 - 1.8\text{ ng/dL}$)

Arterial blood gas on room air reveals a pH of $7.36$, $\text{pCO}_2$ of $48\text{ mm Hg}$, and $\text{pO}_2$ of $65\text{ mm Hg}$.

A $12$-lead electrocardiogram demonstrates $3\text{-mm}$ 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?