While conducting an EKG on your post-myocardial infarction patient, you note the presence of consistently wide QRS complexes greater than 120 ms in duration. What does this most likely indicate?

Correct Answer: A

Rationale: The correct answer is A: An intraventricular conduction delay or right/left bundle branch block. Wide QRS complexes (>120 ms) suggest delayed ventricular depolarization, which can be caused by bundle branch blocks. In the context of a post-myocardial infarction patient, this is a common finding due to damage to the conduction system. Summary: B: A complete heart block is characterized by a lack of communication between the atria and ventricles, leading to a different EKG pattern. C: Wide QRS complexes do not directly indicate a current myocardial infarction; other EKG changes would be seen. D: Wide QRS complexes are not typically associated with congenital heart defects in this scenario, and emergency care may still be necessary.

Correct Answer: B

Rationale: The preferred initial route of administration of epinephrine for an allergic reaction is intramuscular (IM). This is because IM injection allows for rapid absorption and onset of action, making it effective in treating allergic reactions. Subcutaneous (A) may be slower in onset and less reliable for immediate relief. Intravenous (C) administration is reserved for severe cases where immediate effects are needed. Endotracheal (D) route is not recommended for epinephrine administration due to potential complications and lack of reliability. Therefore, option B is the most appropriate initial route for administering epinephrine in a moderate allergic reaction.

Correct Answer: B

Rationale: The correct answer is B: Ischemia. Deep symmetrically inverted T waves on an ECG are indicative of myocardial ischemia, where the heart muscle is not receiving enough oxygen-rich blood. This can lead to reversible changes in the ECG tracing. Ischemia is a common cause of T wave changes in patients with a cardiac history, suggesting ongoing heart strain. Necrosis (choice A) would typically present with pathological Q waves on ECG, not T wave inversions. Hyperkalemia (choice C) may cause peaked T waves, not symmetrically inverted ones. Hypokalemia (choice D) can lead to flattened or U-shaped T waves, not deep symmetric inversions.

Correct Answer: C

Rationale: The correct indication for chest tube insertion is "Massive hemothorax" (Choice C). This is because a massive hemothorax refers to a significant collection of blood in the pleural space, which can lead to compromised lung function and hemodynamic instability. A chest tube is necessary to drain the blood and prevent further complications. Incorrect choices: A: "Pneumothorax" - Chest tube insertion is typically indicated for tension pneumothorax, not simple pneumothorax. B: "Pneumomediastinum" - A chest tube is not typically needed for pneumomediastinum unless there are associated complications. D: "Diaphragmatic rupture" - Chest tube insertion is not the primary intervention for diaphragmatic rupture; surgical repair may be necessary.

Correct Answer: A

Rationale: The correct answer is A: "GCS" (Glasgow Coma Scale). During the primary survey in trauma, assessing the patient's level of consciousness using GCS is crucial to identify any potential brain injury. The patient's airway, breathing, and circulation are already assessed and stable based on the given information. GCS helps determine the severity of head injury and guides further management. B: Cervical spine x-ray is not indicated during the primary survey unless there is suspicion of cervical spine injury based on mechanism of injury or physical exam findings. C: TT-administration (tetanus toxoid) is important but is not a priority during the primary survey. It can be administered later in the secondary survey. D: Blood alcohol level is not necessary during the primary survey for acute trauma management. It can be considered in the secondary survey for further evaluation.