195.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 pain. 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 angu-
lated, and swollen in his anterior thigh area. There is no open wound.
Which of the following is the most likely diagnosis?
a. Hypovolemic shock
b. Neurogenic shock
c. Cardiogenic shock
d. Anaphylactic shock
e. Septic shock
196.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) block. 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?
a. Set the appropriate energy level
b. Position conductor pads or paddles on patient
c. Charge the defibrillator
d. Turn on the synchronization mode
e. Administer 25 μg of fentanyl IV
197.Paramedics bring in a 54-year-old man who was found down in his
apartment by his wife. 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 moni-
tors. You ask the paramedics to hold CPR and assess the patient and the
rhythm strip. The monitor shows sinus bradycardia, but no pulses are pal-
pable. 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 intervention should be performed next?
a. Administer 1 ampule of sodium bicarbonate
b. Administer 1 ampule of calcium gluconate
c. Administer 1 ampule of D50 (dextrose)
d. Place left-sided chest tube
e. Perform pericardiocentesis
210 Emergency Medicine