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) indicate a delay in ventricular depolarization, typically due to conduction abnormalities like bundle branch blocks. In the context of a post-myocardial infarction patient, this finding is common and suggests a conduction issue rather than an acute infarction (choice C). Complete heart block (choice B) would show dissociation between atria and ventricles, not wider QRS complexes. Choice D is incorrect as wide QRS complexes in a post-MI patient require further evaluation and potential intervention.

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.

Correct Answer: D

Rationale: Rationale for Correct Answer (D): Widened symphysis pubis is normal in pregnancy due to hormonal changes softening the ligaments, allowing for increased flexibility during childbirth. This physiological adaptation helps in the delivery process. Summary of Incorrect Choices: A: "Increased residual lung volume" is not normal in pregnancy. Respiratory changes include increased tidal volume and minute ventilation, but residual lung volume does not significantly change. B: Decreased plasma volume is not normal in pregnancy. Plasma volume increases to support the growing fetus and maternal circulation. C: Decreased total RBC mass is not normal in pregnancy. Total RBC mass increases to support increased oxygen demands for the mother and fetus.