Quiz Questions

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Your patient is a 32-year-old woman who was found unresponsive on the floor of her apartment by her boyfriend. He brought her to the ED. You do not see an obvious chest rise or fall.

1. What do you do first?

1. Check the patient's airway for blood, gastric contents, loose dentures, or foreign objects.
2. Listen to find out if the patient is breathing.
3. Place an oral airway and begin ventilation with a bag-mask.
4. Check her carotids for a pulse.

As you complete the primary survey, you note that the patient has no pulse. You tell a team member to begin chest compressions, and you attach her to a defibrillator. The cardiac monitor shows the following rhythm.

2. What type of rhythm does the patient have?

1. Sinus tachycardia
2. Ventricular fibrillation
3. Bradycardia with a prolonged QT interval
4. Bradycardia with third-degree AV block

The patient has no pulse and her blood pressure is 50/110. You determine that the patient has pulseless electrical activity. You instruct a team member to check the patient's ECG rhythm every 2 minutes when team members change positions. A team member starts an IV of normal saline without interrupting CPR.

You are now looking for the cause of PEA.

3. What do you do next?

1. You perform a focused physical exam.
2. You look at the monitor to see if her rhythm has changed.
3. You check for a pulse.
4. You administer 1:10,000 epinephrine IV push.

You learn from her boyfriend that the patient has a past medical history of medication abuse and was admitted to the hospital six months ago.

4. You conclude that the patient most likely has which of the following?

1. Hypothermia
2. Cardiac tamponade
3. Drug overdose
4. Hypovolemia

5. Because the patient has a heart rate slower than 60 bpm, you also request which drug for her?

1. Epinephrine
2. Vasopressin
3. Atropine
4. Epinephrine with saline

6. What would be logical next steps in this patient's care?

1. Order a drug screen
2. Ask her boyfriend if he knows what medications she has been taking
3. Give her a specific antidote after the medication has been identified
4. Keep administering CPR until the drug effects begin to fade
5. All of the above
6. None of the above

Quiz Answers

1. Answer: A. Check the patient's airway for blood, gastric contents, loose dentures, or foreign objects.
2. Answer: C. Bradycardia with prolonged QT interval.
3. Answer: A. You perform a focused physical exam. You are looking for clues about what has caused the patient to deteriorate into PEA.
4. Answer: C. Drug overdose
5. Answer: C. Atropine
6. Answer: E. All of the above