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NEWEST EXAM (JUST RELEASED)
A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with
associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the
respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-
segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent
peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin.
What is the next action? - ANSWER: Administer 2 to 4 mg of morphine by slow IV bolus.
A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She had been
taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is
118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min, and
the pulse oximetry reading is 96%. Which is the most appropriate intervention to perform next? - ANSWER:
Obtain a 12 lead ECG.
A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient's blood pressure is
102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry
reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action? -
ANSWER: Vagal maneuvers
A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. The blood
pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the
pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action
after establishing an IV and obtaining a 12-lead ECG? - ANSWER: Seeking expert consultation
A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest
pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is
14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next? -
ANSWER: Obtain a 12 lead ECG.
, A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood
pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a
pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for
the EMS team to perform next? - ANSWER: Cincinnati Prehospital Stroke Scale assessment
A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min.
The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is
98%. There is vascular access at the left internal jugular vein, and the patient has not been given any
vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or
infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended
intervention? - ANSWER: Adenosine 6mg IV push
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm:
What is the appropriate next intervention? - ANSWER: Defibrillation
A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg,
respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown
below: - ANSWER: Vagal manuever.
A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II
ECG rhythm:
What is the appropriate next intervention? - ANSWER: Synchronized cardioversion
A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is
dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest
priority? - ANSWER: Simple airway manuevers and assisted ventilations.
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine has been given. Which
is the next drug to anticipate to administer? - ANSWER: amiodarone 300 mg
A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks,
epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second
dose of amiodarone is now called for. The recommend second dose of amiodarone is ? - ANSWER: 150 mg IV
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