A middle-aged male walks into the emergency department complaining of chest pain radiating to the ...

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Hypoxia exerts a direct effect on the vomiting center (chemoreceptor trigger zone), producing nausea and vomiting. This direct effect probably accounts for the vomiting that occurs during periods of decreased cardiac output, shock, and environmental hypoxia. We are given no information about the patient's pain tolerance, when he last had a meal, or his routine lifestyle. This patient is going into shock (rapid pulse, low BP) that can result in shunting of blood away from the gut and other organs. During shock, the priority organs for oxygenation include the heart, brain, lungs, and kidneys.