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    Question #342
    A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is incubated and is receiving 100% oxygen.
    During the resuscitation she received 2 doses of epinephrine 1 mg, atropine 1 mg, and lidocaine 100 mg IV. You now observe the above
    rhythm on the cardiac monitor. The rhythm abnormality is becoming more frequent and increasing in number.
    You should order:
          A. Give amiodarone 300 mg IV, start infusion
          B. Give lidocaine 1 to 1.5 mg IV
          C. Repeat epinephrine 1 mg IV
          D. Give lidocaine 0.5 to 0.75 mg/kg IV, start lidocaine infusion
          E. Give amiodarone 150 mg IV, start infusion
    Answer: D
    Question #343
    A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks at you for instruction.
    Your immediate next order is:
          A. Give atropine 1 mg IV
          B. Resume high-quality chest compressions
          C. Give amiodarone 300 mg IV
          D. Perform endotracheal intubation
          E. Give epinephrine 1 mg IV
    Answer: B
    Question #344
    A patient presents with the above rhythm complaining of an irregular heartbeat. She has no other complaints. Past medical history is
    significant for a myocardial infarction 7 years ago. Blood pressure is 110/70 mmHg. At this time you would
          A. Continue monitoring and seek expert consultation
          B. Administer nitroglycerin 0.4 mg sublingual or spray
          C. Perform emergency synchronized cardioversion
          D. Administer lidocaine 1 mo/kg IV
          E. Perform elective synchronized cardioversion with presedation
    Answer: A
    Question #345
    You arrive on-scene to find CPR in progress. Nursing staff report that the patient was recovering from a pulmonary embolism and
    suddenly collapsed. There is no pulse or spontaneous respirations. High-quality CPR is in progress, and effective ventilation is being
    provided with bag-mask. An IV has been initiated. You would now
          A. Initiate transcutaneous pacing
          B. Give epinephrine 1.0 mg IV
          C. Order immediate endotracheal intubation
          D. Give atropine 0.5 mg IV
          E. Give atropine 1 mg IV
    Answer: B
    Question #346
    A 45-year-old woman with a history of palpitations develops lightheadedness and palpitations. She has received adenosine 6 mg IV for
    the rhythm shown above without conversion of the rhythm. She is now extremely apprehensive. Blood pressure is 108/70 mmHg. The
    next appropriate intervention is
          A. Perform vagal maneuvers and repeat adenosine 6 mg IV
          B. Perform immediate unsynchronized cardioversion
          C. Repeat adenosine 12 mg IV
          D. Repeat adenosine 3 mg IV
          E. Sedate and perform synchronized cardioversion
    Answer: C
    Question #347
    You arrive on-scene and find a 56-year-old diabetic woman complaining of chest discomfort. She is pale and diaphoretic, complaining
    of lightheadedness. Her blood pressure is 80/60 mmHg. The cardiac monitor documents the rhythm above. She is receiving oxygen at 4
    L/min by nasal cannula, and an IV has been established. Transcutaneous pacing has been requested but is not yet available.
    Your next order is -
          A. Give morphine sulfate 4 mg IV
          B. Start dopamine at 2 to 10 ug/kg per minute
          C. Give atropine 0.5 mg IV
          D. Give atropine 1 mg IV
          E. Give nitroglycerin 0.4 mg SL
    Answer: C
    Question #348
    You are evaluating a patient with 15-minute duration of chest pain during transportation to the emergency department. He is receiving
    oxygen, and 2 sublingual nitroglycerin tablets have relieved his chest discomfort. He has no complaints but appears anxious. Blood
    pressure is 130/70 mmHg. You observe the above rhythm on the monitor and your next action is
          A. Give atropine 0.5 mg IV
          B. Initiate transcutaneous pacing (TCP)
          C. Continue monitoring patient, prepare for TCP
          D. Administer nitroglycerin 0.4 mg SL
          E. Start epinephrine 2 to 10 ug/min and titrate
    Answer: C
    Question #349
    Following resuscitation with CPR and a single shock, you observe this rhythm while preparing the patient for transport. Your patient is
    stable and blood pressure is
    120/80 mmHg. She is apprehensive but has no complaints other than palpitations. At this time you would
          A. Give magnesium sulfate 1 to 2 g over 20 minutes
          B. Seek expert consultation
          C. Give amiodarone 300 mg IV, start infusion
          D. Give lidocaine 1 to 1.5 mg IV, start lidocaine infusion
    Answer: B
    Question #350
    A patient in the ED develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitored rhythm becomes irregular as seen
    above. Oxygen is being administered by nasal cannula at 4 L/min and an intravenous line is patent. Blood pressure is 160/96 mmHg.
    There are no allergies or contraindications to any medication. You would first order
          A. Lidocaine 1 mg/kg IV and infusion 2 mg/min
          B. Morphine sulfate 2 to 4 mg IV
          C. Nitroglycerin 0.4 mg SL
          D. Amiodarone 150 mg IV
          E. Intravenous nitroglycerin initiated at 10 ug/min and titrated
    Answer: C
    Question #351
    This patient was admitted to the general medical ward with a history of alcoholism. A code is in progress and he has recurrent episodes
    of this rhythm. You review his chart. Notes about the 12- lead ECG say that his baseline QT-interval is top normal to slightly prolonged.
    He has received 2 doses of epinephrine 1 mg and 1 dose of amiodarone 300 mg IV so far. For his next medication you would now order
          A. Repeat amiodarone 150 mg IV
          B. Lidocaine 1 to 1.5 mg IV and start infusion 2 mg/minute
          C. Repeat amiodarone 300 mg IV
          D. Give magnesium sulfate 1 to 2 g IV diluted in 10 ml_ D5W given over 5 to 20 minutes
          E. Give sodium bicarbonate 50 mEq IV
    Answer: D
    Question #352
    This patient suddenly collapsed and is poorly responsive. The patient has a weak carotid pulse. A cardiac monitor, oxygen, and an
    intravenous line have been initiated. The code cart with all drugs and pF transcutaneous pacer is immediately available. Next you would
          A. Initiate dopamine at 10 to 20 ug/kg per minute and titrate heart rate
          B. Give atropine 1 mg IV up to a total dose of 3 mg
          C. Initiate epinephrine at 2 to 10 ug per minute and titrate heart rate
          D. Initiate dopamine at 2 to 10 ug/kg per minute and titrate heart rate
          E. Begin transcutaneous pacing
    Answer: E
    Question #353
    Following initiation of CPR and one shock for VF, this rhythm is present on the next rhythm check. A second shock is given and chest
    compressions are immediately resumed. An IV is in place and no drugs have been given. Bag-mask ventilations are producing visible
    chest rise. What is your next order?
          A. Prepare to give amiodarone 300 mg IV
          B. Administer 3 sequential (stacked) shocks at 360 Joules (monophasic defibrillator)
          C. Perform endotracheal intubation; administer 100% oxygen
          D. Administer 3 sequential (stacked) shocks at 200 Joules (biphasic defibrillator)
          E. Prepare to give epinephrine 1 mg IV
    Answer: E
    Question #354
    A patient with an acute Ml on a 12-lead ECG transmitted by the paramedics has the above findings on a rhythm strip when a monitor is
    placed in the ED. The patient had resolution of moderate (5/10) chest pain with three doses of sublingual nitroglycerin. Blood pressure is
    104/70 mmHg. Which intervention below is most important, reducing in-hospital and 30-day mortality?
          A. Atropine 1 mg IV, total dose 3 mg as needed
          B. Intravenous nitroglycerin for 24 hours
          C. Reperfusion therapy
          D. Atropine 0.5 mg IV, total dose 2 mg as needed
          E. Temporary pacing
    Answer: C


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