You are preparing to perform transcutaneous pacing to your symptomatic bradycardia patient after atropine fails to improve his condition and vital signs. What energy setting should be used initially in an attempt to gain electrical capture in a conscious patient?

Correct Answer: D

Rationale: The correct answer is D: 80 joules. Initially, you should use a higher energy setting to ensure successful capture in a conscious patient. Starting at a higher energy level increases the chances of achieving capture without causing harm. Option A is incorrect because using the highest setting may lead to unnecessary discomfort or injury. Option B is incorrect as using the minimum setting may not provide enough energy for capture. Option C is incorrect as 50 joules may be insufficient for successful pacing in a conscious patient. Starting at 80 joules is a prudent choice to maximize the chance of successful capture while minimizing potential harm.

Correct Answer: A

Rationale: The correct answer is A. To determine death in the pre-hospital environment, EMS professionals must confirm the absence of electrical activity in the heart. Asystole on an EKG tracing indicates no heartbeat, which is a critical criterion for declaring death. Other choices are incorrect because they do not definitively confirm death. Choice B, apnea with a gag reflex, does not necessarily indicate death as the gag reflex can persist after cessation of breathing. Choice C, lividity and cold/clammy skin, are signs of postmortem changes but do not conclusively establish death. Choice D, pinpoint pupils and decreased muscle tone, are indicators of neurological dysfunction but not definitive signs of death.

Correct Answer: D

Rationale: The correct answer is D: Presence of deep tendon reflexes. In hypotension due to spinal cord injury, deep tendon reflexes are typically absent below the level of injury. This is known as spinal shock. The presence of deep tendon reflexes suggests intact spinal cord function and points towards a cause of hypotension other than spinal cord injury. Prispism (A) is not a physical finding associated with hypotension or spinal cord injury. Bradycardia (B) can be a common finding in spinal cord injury due to autonomic dysregulation. Diaphragmatic breathing (C) is also not directly related to hypotension or spinal cord injury.

Correct Answer: D

Rationale: The correct answer is D: Hemorrhage into the chest or abdomen. In this scenario, the man has no open wounds or obvious fractures, ruling out subdural and epidural hematomas. A transected spinal cord would result in neurological deficits rather than shock. Hemorrhage into the chest or abdomen can lead to significant blood loss causing shock, especially in trauma patients. This is supported by the mechanism of injury (motorcycle crash) and the absence of external bleeding.

Correct Answer: C

Rationale: Rationale: C is correct because blood transfusion can be delivered through an intraosseous access in pediatric resuscitation due to the rapid and reliable infusion of fluids and medications. A is incorrect as intraosseous access is considered early in pediatric resuscitation without a set number of percutaneous attempts. B is incorrect as cut down at the ankle is not a preferred access technique in pediatric resuscitation. D is incorrect as internal jugular cannulation is not the next preferred option after failed percutaneous venous access in pediatric resuscitation.