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 initial intervention is to deliver adequate artificial ventilation after ensuring a definitive airway. This is because the newborn's bradycardia and cyanosis indicate respiratory distress, which can lead to decreased oxygenation and poor perfusion. Ventilating the newborn will help improve oxygenation and increase the heart rate. Administering epinephrine or vasopressors would be premature without addressing the underlying cause of respiratory distress. 'Fast and hard' chest compressions are not indicated for a bradycardic newborn with respiratory distress.

Correct Answer: C

Rationale: The correct answer is C: 7.5-8.5 ET tube. This size range is most appropriate for an average adult respiratory arrest patient with no signs of airway trauma or obstruction. Rationale: 1. Size range 7.5-8.5 is standard for adult males and females with average airway anatomy. 2. Choosing too small a tube (option D) can lead to inadequate ventilation. 3. Choosing too large a tube (options A and B) can cause trauma to the airway and increase the risk of complications. 4. Considering the patient has no signs of airway trauma or obstruction, a mid-range size tube (option C) provides a balance between effective ventilation and minimizing potential harm. In summary, option C is the most appropriate choice as it balances the need for effective ventilation while minimizing the risk of complications in an average adult respiratory arrest patient.

Correct Answer: A

Rationale: The correct initial energy setting for synchronized electrical cardioversion in this scenario is option A: Synchronized cardioversion at 50-100 joules. This is because the patient is stable with a narrow complex, regular supraventricular tachycardia, and synchronized cardioversion is indicated for this condition. The recommended starting energy range for synchronized cardioversion in this case is typically 50-100 joules. This energy setting is appropriate for converting supraventricular tachycardia back to sinus rhythm without causing unnecessary harm to the patient. Summary of other choices: - B: Defibrillation at 100 joules: Defibrillation is not indicated for stable supraventricular tachycardia; it is used for ventricular fibrillation or pulseless ventricular tachycardia. - C: Synchronized cardioversion at 360 joules: This energy setting is too high for a stable patient with supraventricular tach

Correct Answer: A

Rationale: The correct answer is A: Obtain a chest x-ray. In a closed head injury with decreased oxygen saturation, it is crucial to rule out potential concomitant injuries like a pulmonary contusion or pneumothorax. Obtaining a chest x-ray will help identify these conditions. Decreasing tidal volume (B) or PEEP (C) may worsen oxygenation. Increasing the rate of assisted ventilations (D) without addressing the underlying cause may not improve oxygen saturation.

Correct Answer: C

Rationale: The correct answer is C: Upper airway protection. This is the highest priority because the patient has marked facial edema and crepitus, indicating potential airway compromise from facial fractures or soft tissue injuries. Protecting the airway is crucial to prevent further complications like respiratory distress or failure. A: Lateral c-spine x-ray - While c-spine injury should be assessed, it is not the highest priority when there is a risk of airway compromise. B: Carotid pulse assessment - While important, it is not the highest priority compared to ensuring adequate airway protection. D: Determination of associated injuries - This can be done after ensuring airway protection, as other injuries may not be immediately life-threatening.