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It is 1000 hours in the emergency department (ED) when the ambulance brings in G.G., a 35 -year-old man who is having difficulty breathing. He complains of chest pain, tightness in the chest, dizziness, palpitations, nausea, paresthesia, and feelings of impending doom. He states, "I don't think I'm going to make it. I must be having a heart attack." He is diaphoretic and trembling. His vital signs are 184 / 92,104,28,98.4F^{\circ} \mathrm{F} (36.9C\left(36.9^{\circ} \mathrm{C}\right. ). These symptoms began at work during a meeting at approximately 0920 and became progressively worse. A co-worker called 911 and stayed with him until the first responder arrived. The patient has no apparent history of cardiac problems.

Following the full medical workup, including testing to rule out MI, pulmonary embolism, and thyroid disorders, it is determined that G.G.'s condition is stable. His shortness of breath and anxiety resolve after he is given lorazepam (Ativan) 1mg1 \mathrm{mg} IV push (IVP). The lab work and ECG results are all within normal parameters, and there is no evidence of any physical disorder. A diagnosis of a panic attack is made. G.G. admits to having had 3 similar episodes in the past 2 weeks; however, they were not nearly as severe or long-lasting.

G.G. shares with the ED staff that he has been under severe stress at work and home. He tells them he is going through a divorce, he lost a child last summer in a motor vehicle accident, and his company is downsizing. He will probably be out of a job soon. He hasn't been sleeping well for the past couple of months and has lost about 20 pounds (9 kg).

G.G.'s condition is stable and the ED physician discusses what has happened with G.G. The physician provides G.G. a prescription for alprazolam (Xanax) 0.5 mg tid for 1 week and a referral to see his primary care physician for further treatment and evaluation. For each class of medications used to treat panic attacks, what will your patient teaching include?


Answer the exercise given below.

Let f(x)=x22xf(x)=x^2-2 x. Find:

(a) f(x)f^{\prime}(x)

(b) f(1),f(1),f(2)f^{\prime}(-1), f^{\prime}(1), f^{\prime}(2)


Answered 1 year ago
Answered 1 year ago
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The derivative of a function f(x)f(x) at a number x=ax=a, denoted by f(a)f' (a), is defined by

f(a)=limh0f(a+h)f(a)h,h0(1)f'(a) = \lim_{h \to 0} \frac{f(a + h) - f(a)}{h}, h\geq 0\tag{1}

if this limit exists.

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