208.A 19-year-old man is brought into the ED by paramedics with a stab
wound to the right lower abdomen. 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 per-
son, 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 focused abdominal sono-
gram for trauma (FAST) examination. Which type of fluid should you start
for his initial resuscitation?
a. 7% Sodium chloride
b. 0.9% Sodium chloride
c. 10% Albumin
d. Type and cross-matched blood
e. Type-specific blood
209.You are notified that emergency medical service (EMS) is bringing in
a patient who collapsed 5 minutes ago in his house and was intubated at
the scene by paramedics. On arrival to the ED, you confirm ET placement
and continue cardiopulmonary resuscitation (CPR). You connect the
patient to the cardiac monitor and see the rhythm below. Which of the fol-
lowing is the most appropriate next step in management?
216 Emergency Medicine
a. Perform synchronized cardioversion at 100 J.
b. Immediately defibrillate at 200 J.
c. Confirm the rhythm in two leads, begin CPR, then defibrillate at 200 J.
d. Confirm the rhythm in two leads, begin CPR, then administer amiodarone.
e. Confirm the rhythm in two leads, begin CPR, then administer epinephrine and
atropine.