An elderly patient is found unconscious and unresponsive. His heart rate is 30 beats per minute, blood pressure is 70/40 mmHg, and his skin is pale and cool. Which intervention should be performed first?

Correct Answer: B

Rationale: The correct answer is B: Establish transcutaneous pacing. This intervention is crucial to immediately address the bradycardia and maintain cardiac output in the elderly patient with symptomatic bradycardia and hypotension. Transcutaneous pacing provides rapid external electrical stimulation to increase the heart rate and improve perfusion. Administering atropine, dopamine infusion, or a fluid bolus of normal saline may not be effective in this scenario as the patient's heart rate is dangerously low, and transcutaneous pacing is the most appropriate intervention to address the underlying cause of the hemodynamic instability.

Correct Answer: B

Rationale: The correct answer is B: A P-R interval greater than five small boxes (0.20 seconds) wide on the electrocardiogram tracing. In first-degree AV block, there is a delay in the conduction of the electrical impulse from the atria to the ventricles, resulting in a prolonged P-R interval. This delay causes the P-R interval to be longer than usual, typically greater than 0.20 seconds. This is indicative of the conduction abnormality seen in first-degree AV block. Incorrect Choices: A: There are more than one P wave for each QRS complex - This describes a condition known as atrial fibrillation where multiple P waves are present without a consistent relationship to the QRS complexes. C: The P-R intervals become progressively longer until a QRS complex is dropped altogether - This describes a Mobitz type II second-degree AV block where there is a sudden drop of a QRS complex without a prior lengthening of the P-R interval.

Correct Answer: D

Rationale: The correct answer is D: To help lower dangerous potassium levels. Albuterol is a beta-2 agonist that stimulates potassium uptake by cells, reducing serum potassium levels. Nebulized albuterol is effective in treating hyperkalemia by shifting potassium into cells, lowering serum levels. Choices A and B are incorrect as albuterol does not directly impact ventilatory status or metabolic acidosis. Choice C is incorrect as albuterol does not increase available calcium at the cellular level.

Correct Answer: D

Rationale: The correct answer is D: Milfeasance. Negligence is divided into three categories: malfeasance, misfeasance, and nonfeasance. Milfeasance is not a recognized category of negligence. Malfeasance refers to intentional wrongdoing, misfeasance refers to negligently performing a legal act, and nonfeasance refers to a failure to act when there is a duty to do so. Milfeasance is not a term used in legal contexts to describe a category of negligence, making it the correct answer.

Correct Answer: C

Rationale: The correct answer is C: Central cord syndrome. This syndrome typically presents with weakness or paralysis in the upper extremities and sparing of the lower extremities due to damage to the central spinal cord. In this case, the man's lack of movement in his lower extremities is indicative of central cord syndrome, likely caused by compression or injury to the cervical spinal cord during the tractor accident. The other choices can be ruled out: A) An epidural hematoma would present with signs of increased intracranial pressure, not paralysis in the lower extremities. B) A pelvic fracture would not directly cause paralysis in the lower extremities. D) Intracerebral hemorrhage would typically present with neurological deficits related to the brain, not the spinal cord.