After assisting a full-term pregnant patient in the delivery of her newborn, the newborn remains bradycardic with a heart rate of 50 beats per minute and exhibits cyanosis around his mouth, nose, fingers, and toes. He is not responding well and appears lethargic following the five-minute APGAR assessment. What would be the best initial intervention at this point to increase his heart rate?

Correct Answer: A

Rationale: The correct answer is A: Deliver adequate artificial ventilation after ensuring a definitive airway. In this scenario, the newborn is bradycardic, cyanotic, and lethargic, indicating possible respiratory distress. The initial intervention should focus on improving oxygenation and ventilation. Providing adequate artificial ventilation after ensuring a definitive airway will help increase oxygen delivery to the newborn's tissues, which can improve the heart rate and overall condition. Epinephrine and vasopressors are not the first-line interventions for bradycardia in a neonate. Fast and hard chest compressions are not recommended as the first step in managing bradycardia in a newborn.

Correct Answer: C

Rationale: The correct answer is C: 7.5-8.5 ET tube. For an adult with no signs of airway trauma or obstruction who is in respiratory arrest, this size range is appropriate. Here's the rationale: 1. Adult size: The range is suitable for an average adult. 2. Apneic adult: The patient is not breathing, requiring intubation for airway management. 3. Timeframe: With a recent collapse, the airway is likely still patent, so a smaller tube is sufficient. 4. No trauma or obstruction: There are no indications for a larger tube. Other choices are incorrect: A: 6.5-8.5 ET tube - This is too broad, and a specific size range is more appropriate. B: 9.0-10.0 ET tube - Larger sizes are not necessary if there are no airway issues. D: 4.5-6.5 ET tube - This size is too small

Correct Answer: A

Rationale: The correct initial energy setting for synchronized electrical cardioversion in a patient with stable supraventricular tachycardia is A: Synchronized cardioversion at 50-100 joules. This is because the patient is hemodynamically stable, with a narrow complex, regular rhythm, and a palpable carotid pulse matching the monitor. The recommended energy range for synchronized cardioversion in such cases is typically between 50-100 joules. This energy level is sufficient to terminate the tachyarrhythmia without causing unnecessary harm to the patient. Choices B, C, and D are incorrect because defibrillation energy settings (100-360 joules) are too high for a stable supraventricular tachycardia patient. Using such high energy levels could lead to unnecessary myocardial damage and potentially worsen the patient's condition. Therefore, the correct choice is A, as it aligns with the principles of providing effective treatment while minimizing the risk of

Correct Answer: A

Rationale: The correct answer is A: Obtain a chest x-ray. When a patient with a closed head injury experiences a decrease in oxygen saturation, it is crucial to rule out potential causes such as a pneumothorax or lung contusion, which can compromise ventilation and oxygenation. A chest x-ray will help identify any underlying pulmonary issues. Decreasing tidal volume (B) or PEEP (C) may not address the specific cause of decreased oxygen saturation in this case. Increasing the rate of assisted ventilations (D) without addressing the underlying issue may not be effective and could potentially worsen the patient's condition.

Correct Answer: C

Rationale: The correct answer is C: Upper airway protection. The highest priority should be given to ensuring the patient's airway is clear and protected, as facial edema and crepitus indicate potential airway compromise. This is crucial to prevent respiratory distress or failure. Assessing the carotid pulse or determining associated injuries can wait until the airway is secured. A lateral c-spine x-ray may be necessary later but is not the immediate priority.