A patient in their 20s presented to the emergency department with presyncope, hives, and nausea after walking outside in the cold. On arrival, their pulse was 120 beats per minute; blood pressure, 85/52 mm Hg; respiratory rate, 20 breaths per minute; oxygen saturation, 100% with a nonrebreather mask; and temperature, 36.8° C. The patient was in moderate respiratory distress, and chest auscultation revealed bilateral wheezing. They were treated for presumed anaphylaxis with 0.5 mg of epinephrine intramuscularly. Immediately after the administration of epinephrine, they developed a headache, nausea, and chest pain. A 12-lead electrocardiogram (ECG) was obtained 5 minutes later (Figure 1). The patient had persistent hypotension.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Maxim Ben-Yakov, MDCM, Division of Emergency Medicine, University of Toronto, Toronto General Hospital, 480-200 Elizabeth St, R. Fraser Elliot Building, Ground, Toronto, ON M5G 2C4, Canada (email@example.com).
Published Online: April 21, 2021. doi:10.1001/jamacardio.2021.0749
Conflict of Interest Disclosures: None reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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