Home Medical QuizzesEmergency Quizzes The Quizzes about Trauma, Shock, and Resuscitation – Part 3 (18 test)

The Quizzes about Trauma, Shock, and Resuscitation – Part 3 (18 test)

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Trauma, Shock, and Resuscitation-3

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See all quizzes of  the Trauma, Shock, and Resuscitation  at here:

Part 1 (20 test) | Part 2 (20 test) | Part 3 (18 test – end)

II. Preview all questions below

1. A 79-year-old woman with a history of coronary artery disease who underwent a coronary artery bypass graft (CABG) surgery 7 years ago is brought to the emergency department (ED) by her family for 2 days of worsening shortness of For the past 2 days, she has not gotten out of bed and is confused. She does not have chest pain, fevers, or cough. Her temperature is 98.1°F, blood pressure (BP) is 85/50 mm Hg, heart rate (HR) is 125 beats per minute, and respiratory rate (RR) is 26 breaths per minute. On examination, she is unable to follow commands and is oriented only to name. The cardiovascular examination reveals tachycardia with no murmurs. Her lungs have rales bilaterally at the bases. The abdomen is soft, nontender, and nondistended. Lower extremities have 2+ edema to the knee bilaterally. Which of the following is the most likely diagnosis?

  1. Hypovolemic shock
  2. Neurogenic shock
  3. Cardiogenic shock
  4. Anaphylactic shock
  5. Septic shock

 

2. A 32-year-old man with no past medical problems presents to the ED with For the past 2 days he has been feeling weak and over the last 6 hours he has noticed that his heart is racing. He has no chest pain or shortness of breath. He has never felt this way before. His temperature is 98.9°F, BP is 140/82 mm Hg, HR is 180 beats per minute, and RR is 14 breaths per minute. His physical examination is normal. You obtain the following rhythm strip. What is your first-line treatment for this patient?

 

  1. Synchronized cardioversion at 100 J
  2. Adenosine 6-mg intravenous (IV) push
  3. Adenosine 12-mg IV push
  4. Valsalva maneuver
  5. Verapamil 3-mg IV push

 

3. You are a passenger aboard an airplane and a 78-year-old woman is complaining of chest pain and difficulty You are the only medical professional available and volunteer to help. Fortunately, the aircraft is well-equipped with basic medical equipment, as well as with ACLS medications and a cardiac monitor. On examination, the passenger’s BP is 75/40 mm Hg, HR is 180 beats per minute, and RR is 24 breaths per minute. On examination, the patient is in obvious distress but able to answer basic questions. Her heart is tachycardic, regular, and without mur- murs, rubs, or gallops. Physical examination is remarkable for a bounding carotid pulse. You attach the cardiac monitor and see a regular rhythm at 180 beats per minute with wide QRS complexes and no obvious P waves. After asking the pilot to make an emergency landing, what do you do next?

  1. Amiodarone IV
  2. Synchronized  cardioversion
  3. Verapamil IV
  4. Lidocaine IV
  5. Procainamide IV

 

4. A 41-year-old man is brought into the ED by paramedics in cardio- pulmonary A friend states that the patient is a long-time user of IV heroin. You look at the monitor and see that the patient has pulseless elec- trical activity (PEA). Cardiopulmonary resuscitation is being performed and the patient is intubated. You decide to administer epinephrine to the patient but realize that he does not have IV access. Which of the follow- ing drugs is ineffective when administered through an endotracheal (ET) tube?

  1. Atropine
  2. Naloxone
  3. Lidocaine
  4. Epinephrine
  5. Sodium bicarbonate

 

5. A 75-year-old man complaining of chest pain is brought into the ED by He is barely able to speak to you because he is short of breath. The nurse immediately attaches him to the monitor, starts an IV, and gives him oxygen. His temperature is 98.9°F, BP is 70/40 mm Hg, HR is 140 beats per minute, RR is 28 breaths per minute, and oxygen saturation is 95% on room air. On examination, he is in mild distress. His heart is irregular and tachycardic. His lungs are clear to auscultation, with rales at the bases, bilaterally. An electrocardiogram (ECG) is shown below. What is your first-line treatment for this patient?

  1. Heparin drip
  2. Diltiazem 10-mg IV push
  3. Metoprolol 5-mg IV push
  4. Digoxin 0.5-mg IV
  5. Synchronized cardioversion at 100 J

 

6. A 19-year-old man was struck by a motor vehicle while crossing the street. In the ED, he is awake, alert, and oriented but complaining of severe right leg His temperature is 98.9°F, BP is 85/50 mm Hg, HR is 125 beats per minute, and RR is 24 breaths per minute. You confirm that his airway is patent, breath sounds are equal bilaterally, and his abdomen is soft and nontender. His right leg is shorter than his left leg, slightly angulated, and swollen in his anterior thigh area. There is no open wound. Which of the following is the most likely diagnosis?

  1. Hypovolemic shock
  2. Neurogenic shock
  3. Cardiogenic shock
  4. Anaphylactic shock
  5. Septic shock

 

7. You are called to the bedside of a hypotensive patient with altered mental status. The nurse hands you an ECG which shows atrial flutter at 150 beats per minute with 2:1 arteriovenous (AV) You feel that the patient is unstable and elect to perform emergency cardioversion. You attach the monitor leads to the patient. What is the critical next step in electrical cardioversion?

  1. Set the appropriate energy level.
  2. Position conductor pads or paddles on patient.
  3. Charge the defibrillator.
  4. Turn on the synchronization mode.
  5. Administer 25 mg of fentanyl IV.

 

8. Paramedics bring in a 54-year-old man who was found down in his apartment by his He is successfully intubated in the field and para- medics are currently performing cardiopulmonary resuscitation (CPR). He is transferred to an ED gurney and quickly attached to the cardiac monitors. You ask the paramedics to hold CPR and assess the patient and the rhythm strip. The monitor shows sinus bradycardia, but no pulses are palpable. On examination you appreciate bilateral breath sounds with mechanical ventilation, a soft abdomen, no rashes, and a left arm AV graft. In addition to CPR with epinephrine and atropine every 3 to 5 minutes, which inter- vention should be performed next?

  1. Administer 1 ampule of sodium bicarbonate.
  2. Administer 1 ampule of calcium gluconate.
  3. Administer 1 ampule of D50 (dextrose).
  4. Place left-sided chest tube.
  5. Perform pericardiocentesis.

 

9. A 72-year-old man is in the ED for the evaluation of generalized weakness over the previous 24 He has a past medical history of coronary artery disease with a CABG performed 5 years ago, diabetes mellitus, and arthritis. The nurse places the patient on a cardiac monitor and begins to get his vital signs. While the nurse is obtaining the vital signs, she notices that the patient suddenly becomes unresponsive. You arrive at the bedside, look at the monitor, and see the following rhythm. Which of the following is the most appropriate next step in management?

  1. Wait 5 minutes to see if he awakens on his own.
  2. Immediately defibrillate at 200 J (biphasic).
  3. Perform synchronized cardioversion at 100 J.
  4. Immediately intubate the patient.
  5. Insert an IV line and administer amiodarone.

 

10. An 82-year-old nursing home patient presents to the ED in septic Her BP is 75/40 mm Hg, HR is 117 beats per minute, temperature is 96.5°F, RR is 29 breaths per minute, and oxygen saturation is 87% on room air. As you perform laryngoscopy to intubate the patient, you easily visual- ize the vocal cords and subsequently pass the orotracheal tube through the vocal cords. You place the colorimetric end-tidal carbon dioxide device over the tube and get appropriate color change. There are equal, bilateral breath sounds on auscultation and you observe chest wall motion with ventilation. Which of the following is the most reliable method for verify- ing proper ET tube placement?

  1. Chest radiograph
  2. Visualization of the ET tube passing through the vocal cords
  3. Observation of chest wall motion with ventilation
  4. Hearing equal, bilateral breath sounds on auscultation
  5. End-tidal carbon dioxide color change

 

11. A 25-year-old man fell off his surfboard and landed on He was pulled from the water by lifeguards and brought to the ED in full cervical and spinal immobilization. He is alert and oriented to person, place, and time. He is complaining of weakness in all of his extremities. His tem- perature is 98.4°F, BP is 85/50 mm Hg, HR is 60 beats per minute, RR is 20 breaths per minute, and oxygen saturation is 98% on room air. On examination, he has no external signs of head injury. His heart is brady- cardic without murmurs. The lungs are clear to auscultation and the abdo- men is soft and nontender. He has grossly normal peripheral sensation but no motor strength in all four extremities. Which of the following is the most likely diagnosis?

  1. Hypovolemic shock
  2. Neurogenic shock
  3. Cardiogenic shock
  4. Anaphylactic shock
  5. Septic shock

 

12. A 48-year-old man is brought to the ED by paramedics for general- ized His medical history is significant for a CABG last month. He has been unable to get out of bed for the past day because of dizzi- ness when changing position. He denies chest pain, shortness of breath, or syncope. His temperature is 98.9°F, BP is 86/60 mm Hg, HR is 44 beats per minute, RR is 18 breaths per minute, and oxygen saturation is 98% on room air. There is a well-healing midline sternotomy incision. Cardiac examination reveals a III/VI systolic ejection murmur. There are minimal rales at his lung bases. He is immediately attached to the cardiac monitor. His rhythm strip is shown below. What is your initial treatment?

  1. Observation on monitor
  2. Transcutaneous pacing
  3. Transvenous pacing
  4. Atropine 0.5 mg IV
  5. Epinephrine IV drip at 2 mg/minute

 

13. You are caring for a 54-year-old woman with a history of schizophrenia and coronary artery disease who presents to the ED for chest Her vital signs are within normal limits and her ECG is normal sinus rhythm with nonspecific ST/T-wave changes. Her first troponin is sent to the laboratory and you are planning to admit her to the hospital for a complete acute coronary syndrome (ACS) evaluation. She receives aspirin and nitroglyc- erin and her chest pain resolves. A few minutes later, the nurse alerts you that the patient has become unconscious. You go to the bedside and find the patient awake and alert. You review the rhythm strip below. What is your next step in management?

  1. Observation of patient
  2. Magnesium sulfate IV
  3. Lidocaine IV
  4. Transvenous pacemaker
  5. Isoproterenol IV

 

14. A 19-year-old man is brought into the ED by paramedics with a stab wound to the right lower The medics applied a pressure dress- ing and started an IV line en route to the hospital. On arrival, the patient has no complaints and wants to leave. His temperature is 98.4°F, BP is 130/95 mm Hg, HR is 111 beats per minute, RR is 20 breaths per minute, and oxygen saturation is 98% on room air. He is alert and oriented to person, place, and time. His abdomen is soft and nontender, with normal bowel sounds. He has a 2-cm stab wound with visible subcutaneous fat in his right lower quadrant (RLQ). You initiate the FAST examination. Which type of fluid should you start for his initial resuscitation?

  1. 7% sodium chloride
  2. 0.9% sodium chloride
  3. 10% albumin
  4. Type and cross-matched blood
  5. Type-specific blood

 

15. An 82-year-old man with a history of COPD and hypertension pres- ents with shortness of breath and His medications include albuterol, ipratropium, prednisone, hydrochlorothiazide, and atenolol. His tempera- ture is 102.1°F, BP is 70/40 mm Hg, HR is 110 beats per minute, RR is 24 breaths per minute, and oxygen saturation is 91% on room air. The patient is uncomfortable and mumbling incoherently. On chest examina- tion, you appreciate rales on the left side of his chest. His heart is tachy- cardic, but regular with no murmurs, rubs, or gallops. His abdomen is soft and nontender. You believe this patient is in septic shock from pneumonia and start IV fluids, broad-spectrum antibiotics, and a dopamine drip. His BP remains at 75/50 mm Hg. Which of the following is the most appropri- ate next step in management?

  1. D5 normal saline IV bolus
  2. Phenylephrine IV drip
  3. Fludrocortisone IV
  4. Hydrocortisone IV
  5. Epinephrine IV drip

 

16. A 64-year-old woman with a history of depression and hypertension was found down by her husband and brought in by the Her husband says that she has recently been depressed and expressed thoughts of suicide. She usually takes fluoxetine for depression and atenolol for hypertension. On arrival, the patient is obtunded, but responds to pain and is maintaining her airway. Her temperature is 98.1°F, BP is 70/40 mm Hg, HR is 42 beats per minute, RR is 12 breaths per minute, and oxygen saturation is 94% on room air. On examination, her pupils are 3 mm and reactive bilaterally. Lungs are clear to auscultation. Heart is bradycardic, but regular, with no murmurs, rubs, or gallops. Extremities have no edema. An ECG shows first-degree AV block at 42 beats per minute, but no ST/T- wave changes. Blood sugar is 112 mg/dL. What is the most specific treat- ment for this patient’s ingestion?

  1. Fluid bolus
  2. Atropine
  3. Glucagon
  4. Epinephrine
  5. Cardiac pacing

 

17. A 19-year-old man suffers a single gunshot wound to the left chest and is brought in by his He is complaining of chest pain. On exam- ination, his temperature is 99°F, BP is 70/40 mm Hg, HR is 140 beats per minute, RR is 16 breaths per minute, and oxygen saturation is 96% on room air. He has distended neck veins, but his trachea is not deviated. Lungs are clear to auscultation bilaterally. Heart sounds are difficult to appreciate, but you feel a bounding, regular pulse. Abdomen is soft and nontender. Extremity examination is normal. Two large-bore IV lines are placed and the patient is given 2 L of normal saline. Chest radiograph shows a globular cardiac silhouette but a normal mediastinum and no pneumothorax. What is the definitive management of this patient?

  1. Intubation
  2. Tube  thoracostomy
  3. Pericardiocentesis
  4. Thoracotomy
  5. Blood transfusion

 

18. An 87-year-old woman with a history of dementia, arthritis, and hypertension presents to the ED for abdominal Her caretaker reports that she is having mid-epigastric pain and had one episode of nonbloody, nonbilious vomiting prior to arrival. The patient is oriented to name only. Temperature is 99.8°F, HR is 110 beats per minute, BP is 80/44 mm Hg, RR is 16 breaths per minute, and oxygen saturation is 96% on room air. On examination, the abdomen is soft, nontender, with no masses, rebound or guarding. Stool is brown and guaiac negative. You place two IV lines and begin fluid resuscitation. You send her blood to the laboratory and order a radiograph of her chest that is shown below. Which of the following is the most appropriate next step in management?

  1. Start IV antibiotics.
  2. Order a CT scan of her abdomen.
  3. Call the surgery service.
  4. Place a central venous line.
  5. Discharge home with Maalox.

 

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