---
title: 55-year-old man with a history of COPD and hypertension
description: It's COPD Quiz Time with Med-Challenger!
---

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# [55-year-old man with a history of COPD and hypertension](https://challengercme.com/blog/55-year-old-man-with-a-history-of-copd-and-hypertension)

 Written by [Med-Challenger](https://challengercme.com/blog/author/med-challenger) | Nov 28, 2024 3:45:00 PM

A 55-year-old man with a history of chronic obstructive pulmonary disease (COPD) and hypertension, comes in with acute dyspnea, and has run out of his medications.  He complains of palpitations for less than 24 hours.

His vital signs are BP, 140/85; P, 105; RR, 20; T, 98.6 F; pulse oximetry is 92% on room air.  His exam is remarkable for a rapid heart rate of uncertain rhythm, and his lung exam shows decreased air movement.  His lab work includes a calcium 8.9 mg/dL; magnesium 2 mg/dL; potassium 3.8 meq/L ([click here for reference lab values](https://s3.amazonaws.com/challmedia/PDF/d47ae88b18314bc6ac7d8166621dfa00.pdf)); ECG shows variable rate around 105; p waves of varying morphology; variable P-P, PR, and R-R intervals (see below ECG).

What is the most appropriate treatment for this particular patient, given these ECG findings?

- Magnesium IV
- Synchronized cardioversion
- Nebulized beta-agonists
- 100%FiO2 via non-rebreather mask
- Diltiazem

 

This question appears in [Med-Challenger Emergency Medicine Review with CME](https://challengercme.com/emergency-medicine-exam-review-cme-course)

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