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 greater than 120 ms duration typically indicate an intraventricular conduction delay, such as a bundle branch block. In the context of a post-myocardial infarction patient, this finding is common due to damage to the conduction system. Bundle branch blocks can lead to widened QRS complexes. Summary: B: A complete heart block is incorrect as it would typically present with a different EKG pattern. C: While a myocardial infarction can cause conduction abnormalities, the widened QRS complexes are not indicative of an acute infarction. D: Congenital heart defects are not typically associated with wide QRS complexes in a post-myocardial infarction patient.

Correct Answer: B

Rationale: The preferred initial route of administration for epinephrine in an allergic reaction is intramuscular (IM) injection (Choice B) because it ensures rapid absorption and onset of action. Epinephrine acts quickly when injected into the muscle, reaching the bloodstream efficiently to counteract allergic reactions. Subcutaneous (Choice A) administration may lead to slower absorption. Intravenous (Choice C) administration is too invasive and can result in rapid, potentially dangerous effects. Endotracheal (Choice D) administration is not recommended for epinephrine as it is not a standard route and may not provide the desired therapeutic effects.

Correct Answer: B

Rationale: Rationale: Inverted T waves are typically indicative of myocardial ischemia. Ischemia leads to altered repolarization of the ventricles, causing T wave inversions. Necrosis (choice A) would manifest as pathological Q waves rather than T wave inversions. Hyperkalemia (choice C) would cause peaked T waves, not inverted T waves. Hypokalemia (choice D) could lead to U waves or flattened T waves, but not deep symmetric T wave inversions. Therefore, choice B (Ischemia) is the most likely cause based on the presented scenario and ECG findings.

Correct Answer: C

Rationale: The correct answer is C, "Massive hemothorax." Chest tube insertion is indicated for draining blood or other fluids from the pleural space to restore normal lung function. Massive hemothorax refers to a significant accumulation of blood in the pleural cavity, which can lead to respiratory compromise. Inserting a chest tube helps evacuate the blood, relieve pressure on the lungs, and prevent complications like tension pneumothorax. Choice A, "Pneumothorax," usually requires chest tube insertion for air drainage, not blood. Choice B, "Pneumomediastinum," typically does not require chest tube insertion but may need conservative management. Choice D, "Diaphragmatic rupture," may lead to hemothorax, but chest tube insertion would be indicated for the hemothorax itself, not the diaphragmatic rupture.

Correct Answer: A

Rationale: The correct answer is A: "GCS" (Glasgow Coma Scale). During the primary survey, assessing the patient's level of consciousness using the Glasgow Coma Scale is crucial for identifying any potential head injuries or altered mental status due to trauma. This assessment helps determine the severity of the patient's condition and guides further management. B: Cervical spine x-ray is not indicated during the primary survey as it is more appropriate in the secondary survey to evaluate for potential cervical spine injuries. C: TT-administration (tetanus toxoid) is important for management but not a priority during the primary survey. It can be addressed later in the treatment process. D: Blood alcohol level is not crucial during the primary survey for immediate life-saving interventions. It can be considered in the secondary survey for further evaluation.