193.A 41-year-old man is brought into the ED by paramedics in car-
diopulmonary arrest. 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
electrical 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 following
drugs is ineffectivewhen administered through an endotracheal (ET) tube?
a. Atropine
b. Naloxone
c. Lidocaine
d. Epinephrine
e. Sodium bicarbonate
194.A 75-year old man complaining of chest pain is brought in to the ED
by paramedics. 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 satura-
tion 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?
Shock and Resuscitation 209a. Heparin drip
b. Diltiazem 10 mg IV push
c. Metoprolol 5 mg IV push
d. Digoxin 0.5 mg IV
e. Synchronized cardioversion at 100 J