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: Step 1: Wide QRS complexes greater than 120 ms indicate abnormal conduction in the ventricles. Step 2: An intraventricular conduction delay or bundle branch block can cause widened QRS complexes. Step 3: In post-myocardial infarction patients, conduction abnormalities like bundle branch blocks are common. Step 4: Choice A is correct as it aligns with the common occurrence of conduction delays post-MI. Step 5: Choices B, C, and D are incorrect as they do not directly relate to widened QRS complexes in this context.

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.

Correct Answer: D

Rationale: Step-by-step rationale for why option D is correct: 1. During pregnancy, the hormone relaxin causes the symphysis pubis to widen to accommodate childbirth. 2. This widening of the symphysis pubis is a normal physiological change in pregnancy to facilitate the passage of the baby. 3. It is essential for the baby to pass through the birth canal during labor. 4. Therefore, a widened symphysis pubis is a normal finding in pregnancy. Summary of why other choices are incorrect: A. "Increased residual lung volume" is not normal in pregnancy as lung volume decreases due to the elevation of the diaphragm. B. "Decreased plasma volume" is not normal in pregnancy as plasma volume increases to support the growing fetus. C. "Decreased total RBC mass" is not normal in pregnancy as RBC mass increases to meet the increased oxygen demands.