A 68-Year-Old Man Undergoing Hemodialysis Is Being Evaluated Due to "Difficulty

A 68-year-old man undergoing hemodialysis is being evaluated due to "difficulty breathing and chest tightness."  He has not had any chest pain.  The patient was feeling well when he arrived at his hemodialysis appointment.  He was started on hemodialysis 15 minutes ago after a heparin flush; an intravenous iron infusion was started 5 minutes ago for iron deficiency anemia.  Medical history is significant for end-stage renal disease due to uncontrolled hypertension, a small pericardial effusion, and small, bilateral pleural effusions.  He has been on hemodialysis treatment for the past year.  Temperature is 35.6 C (96.1 F) , blood pressure is 90/60 mm Hg, pulse is 112/min, and respirations are 24/min.  Pulse oximetry is 93% on room air.  The patient is alert but in mild distress.  Conjunctivae are pale.  Lungs sounds are decreased at both bases.  Bilateral wheezing is noted on auscultation of the lungs.  Heart sounds are slightly muffled and rapid but without murmurs or rubs.  Abdomen is soft and nontender.  Skin is flushed.  Mild, bilateral pitting pedal edema is present.  What is the most likely cause of this patient's symptoms?

A) Acute myocardial infarction
B) Air embolism
C) Anaphylaxis
D) Pericardial tamponade
E) Pulmonary embolism

Correct Answer:

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