200.As you arrive for your ED shift, you are called to help with a “coding”
patient. The senior resident has just intubated the patient and the nurses
have established IV access and attached the cardiac monitor. An emergency
medical treatment (EMT) student is performing chest compressions. You
ask the EMT student to stop compressions. The monitor shows a flat line
with no electrical activity. You are unable to detect any pulses. What is your
next step in management?
a. Defibrillate at 360 J
b. Epinephrine 1-mg IV push
c. Atropine 1-mg IV push
d. Ask the nurse to run a rhythm strip in an additional lead
e. Apply transcutaneous pacers
201.A 34-year-old woman with no known medical problems is having a
sushi dinner with her husband. Halfway through dinner, she begins
scratching her arms and her husband notices that her face is flushed. The
itching intensifies and she begins to feel chest pain, shortness of breath,
and dizziness. On arrival to the ED, she can barely talk. Her temperature is
100 °F, BP is 85/50 mm Hg, HR is 125 beats per minute, and RR is 26 breaths
per minute, and oxygen saturation is 91% on room air. Which of the
following is the most likely diagnosis?
a. Hypovolemic shock
b. Neurogenic shock
c. Cardiogenic shock
d. Anaphylactic shock
e. Septic shock
202.An 82-year-old nursing home patient presents to the ED in septic
shock. 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
visualize the vocal cords and subsequently pass the orotracheal tube
through the vocal cords. You place the colorimetric end-tidal carbon diox-
ide 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
verifying proper ET tube placement?
a. Chest radiograph
b. Visualization of the ET tube passing through the vocal cords
c. Observation of chest wall motion with ventilation
d. Hearing equal, bilateral breath sounds on auscultation
e. End-tidal carbon dioxide color change
212 Emergency Medicine