Task: Question Answering
Input (English): Question: A 78-year-old woman is undergoing surgery to implant a definitive pacemaker for atrio-ventricular block. His personal history includes high blood pressure, hypercholesterolemia, diabetes mellitus and morbid obesity. The procedure is long and laborious due to the obesity of the patient and is carried out through infiltrations with local anesthetic. At forty-five minutes after the beginning of the intervention, she begins to show agitation and progressive disorientation. She says she is dizzy and does not see or hear well. Physical examination shows a discrete bilateral mydriasis, shivering and distal tremors in the upper extremities. What would be the most logical attitude to follow in this clinical picture? 
 Options:  <1> Neurological symptomatology leads to toxicity due to local anesthetics. The administration of local anesthetic should be interrupted, intravenous diazepam or midazolam administered, the procedure completed as soon as possible and the patient placed under clinical observation. <2> The symptomatology is clearly compatible with an acute ischemic stroke. The neurological examination must be completed once the implantation of the pacemaker has been completed and treatment with low molecular weight heparin has begun at a dose of 0.5 mg per kg per day, after an urgent CT scan. <3> The clinical picture is compatible with an anxiety crisis caused by pain during implantation of the pacemaker. The correct treatment includes a greater infiltration with the local anesthetic to relieve pain and the administration of intravenous diazepam for its anxiolytic effects. <4> Given the clinical history of the patient, it is most likely that she is suffering from an acute coronary syndrome. An electrocardiogram should be performed, obtain a CPK-MB determination and notify Cardiology to initiate the appropriate treatment. <5> An urgent determination of blood glucose should be made, since the clinical picture could correspond to a diabetic ketoacidosis.
Output (English): 1