A woman was struck by lightning while working in her garden. Her husband tells you that when he first found her, she was unconscious and not breathing. Your assessment reveals that she is conscious and alert, but has no recollection of the event. Her airway is patent, and her breathing is adequate. Her blood pressure is 134/74mmHg, pulse is 88bpm, and respirations are 20. The cardiac monitor reveals a sinus rhythm without ectopy. She is moving all of her extremities and has no obvious burns or musculoskeletal injuries. She refuses to allow you to apply a cervical collar and place her onto a backboard, but consents to other treatment and transport. The MOST appropriate treatment for this patient includes:
a. High flow oxygen, continuous cardiac monitoring, two large-bore IV lines, a 500mL saline bolus, and transport
b. Supplemental oxygen, an IV line of normal saline, 5mg diazepam to prevent seizures, and prompt transport
c. 100% oxygen via nonrebreather mask, cardiac monitoring, an IV line set to keep the vein open, 1 to 1.5mg/kg of lidocaine, and transport.
d. Oxygen via nasal cannula or nonrebreather mask, 12-lead ECG acquisition, continuous cardiac monitoring, an IV line set to keep the vein open and transport. You are assessing a 67-year-old female with chest discomfort when she becomes unresponsive, apneic, and pulseless. The cardiac monitor reveals coarse ventricular fibrillation. You achieve return of spontaneous circulation after 4 minutes and the cardiac monitor now reveals a narrow complex rhythm. The patient is still unresponsive, has occasional respirations, blood pressure of 70/40 and a weak pulse of 70. The MOST appropriate post resuscitation care for this patient includes:
a. Insertion of an airway adjunct, assisted ventilation with a bag-valve-mask device, vascular access, a 500-1000mL crystalloid fluid bolus, and an amiodarone infusion at 1mg/min.
b. Preoxygenation with a bvm and high flow oxygen, endotracheal intubation, vascular access, 300mg of amiodarone, and a dopamine infusion.
c. Insertion of a supraglottic airway device, ventilatory assistance, vascular access, 150mg of amiodarone over 10 minutes, and 0.5mg of atropine sulfate.
d. Oxygen via nonrebreather mask, vascular access, a lidocaine infusion, an adequate volume of normal saline solution to increase her blood pressure. You are assessing a 75-year-old male who experienced a sudden onset of slurred speech, a right sided facial droop, and left-sided hemiparesis approximately 45 minutes ago. His blood pressure is 170/94, pulse 68 and irregular, and respirations are 14 and unlabored. His o2 saturation is 92% on room air. The MOST appropriate treatment for this patient includes:
a. Oxygen via nonrebreathing mask, an IV normal saline, cardiac monitoring, 5mg of labetalol to lower his Bp, blood glucose assessment, and rapid transport.
b. 160 to 325mg of aspirin, supplemental o2 via nasal cannula, cardiac monitoring, blood glucose assessment, an IV of isotonic crystalloid, and transport
c. Assisted ventilation with a bag-valve mask device, cardiac monitoring, an IV of normal saline, IV dextrose if his blood glucose level is less than 80mg/dL, and transport
d. Supplemental o2 via nasal cannula, cardiac monitoring, blood glucose assessment, an IV of normal saline set to keep the vein open, and prompt transport A 61-year-old male presents with chest pressure that woke him up from his nap 30 minutes ago. He is diaphoretic, anxious, and rates his pain as an 8 over 10. His past medical history is significant for hypertension, type II diabetes, and coronary stent replacement 2 months ago. He takes lisinopril, plavix, and glucophage and is wearing a medical alert bracelet stating "allergic to salicylates". His blood pressure is 160/100, pulse 110, and respirations are 22. The 12-lead ECG shows sinus tachycardia with 3mm ST segment elevations in leads V1 though V4. Which of the following treatment modalities is MOST appropriate for this patient?
a. 325mg of baby aspirin; high flow oxygen via non rebreathing mask; vascular access; and 1ug/kg of fentanyl to relieve his pain, treat his anxiety, and lower his bp.
b. High flow oxygen via non rebreathing mask, a right sided 12 lead ECG, vascular access, 0.25mg/kg diltiazem, and application of pacing pads in case he becomes bradycardic
c. Supplemental oxygen, vascular access, up to three 0.4mg doses of nitroglycerine, and 2 to 4 mg of morphine sulfate if his systolic Bp is greater than 90 and he is still experiencing pain
d. 325mg of baby aspirin, supplemental oxygen, vascular access, up to three doses of nitroglycerine, and up to 10mg of morphine if his systolic Bp is greater than 120 and he is still in pain Which of the following clinical presentations is MOST consistent with an acute ischemic stroke involving the left cerebral hemisphere?
a. Dysarthria, confusion, left side hemiparesis, left Side facial droop
b. Dysphasia, confusion, right side hemiparesis, left Side facial droop
c. Decerebrate posturing, asymmetric pupils, hypertension, bradycardia
d. Aphasia, lethargy, right side hemiparesis, right side facial droop You are attempting tl resuscitate a 50-year-old man in cardiac arrest. The patient has a history of CHF, HTN, and cirrhosis of the liver. The cardiac monitor reveals a slow, wide complex rhythm. CPR is ongoing and the patient has been intubated. In addition to looking for potentially reversible causes of the patients condition, further treatment should include:
a. Hyperventilation for presumed acidosis and 1mg of epi 1:10,000 every 3 to 5 minutes
b. One breath every 3 to 5 seconds, a 2-liter normal saline bolus, a vasopressor, and a dopamine infusion
c. Ventilations at a rate of 10 breaths per minute and 1mg of epi 1:10,000 every 3 to 5 minutes
d. One breath every 5 to 6 seconds, 300mg of amiodarone, and transcutaneous pacing A 70-year-old man presents with an acute onset of confusion, slurred speech, and left side weakness. According to his daughter, he has high blood pressure and has had several "small strokes" over the past 6 months. Your partner applies supplemental o2, assesses his vital signs, which are stable, and assesses his blood glucose level which reads 35mg/dL. You attempt to perform the cincinatti stroke test but the patient is unable to understand your instructions. After establishing IV access, you should:
a. Give 324mg of baby aspirin, place him in a supine position, monitor his cardiac rhythm and transport
b. Administer oral glucose, place him in a semi sitting position, monitor his cardiac rhythm, and trasnport
c. Monitor his cardiac rhythm, withhold glucose in case he is having a hemorrhagic stroke, and transport
d. Administer 50% dextrose, monitor his cardiac rhythm, protect his impaired extremities and transport Which of the following clinical presentations is MOST consistent with dissection of the ascending aorta?
a. Tearing abdominal pain unrelieved by analgesia, pulse deficit in the femoral arteries, lightheadedness, blood in the stool
b. Sudden onset of lower back pain that radiates to the groin, urge to defecate, pain Is constant and moderate in severity
c. Gradual onset of chest pressure that increases in severity over time, hypotension, tachycardia, bilaterally weak radial pulses
d. Acute tearing pain in between the scapulae, blood pressure discrepancy between arms, maximal pain severity from the onset During resuscitation of a 60 year old man with v fib, you restore ROSC following CPR, defibrillation, two doses of epi, and one dose of amino. The patient remains unresponsive and apneic. Which of the following represents the MOST appropriate post-arrest care for this patient?
a. Ventilate at a rate of 10-12 breaths, support blood pressure and obtain a 12 lead ECG
b. Hyperventilate the patient, administer normal saline bolus, and begin an amiodarone infusion at 0.5mg/min
c. Ventilate at a rate of 10 breaths, support blood pressure and give 150 mg of amino over 10 min
d. Ventilate at a rate of 20 breaths, begin epi infusion to maintain perfusion, and keep the patient warm