Your 49-year-old COPD patient is unconscious and exhibiting ineffective respirations. You quickly decide to attempt to control his airway and provide positive pressure ventilations. Which airway adjunct has a large distal end with an inflatable cuff that presses against the patient's esophageal sphincter while the proximal border of the airway device rests against the patient's tongue?

Correct Answer: B

Rationale: The correct answer is B: Esophageal-Tracheal Combi-tube. The Combi-tube has a large distal end with an inflatable cuff that presses against the esophageal sphincter, preventing gastric insufflation. The proximal border rests against the tongue, providing a secure airway. This device is specifically designed for unconscious patients with ineffective respirations, like the COPD patient in this scenario. A: King LTD airway is a supraglottic airway device used for difficult airways but does not have the same features as the Combi-tube for unconscious patients. C: Laryngeal Mask Airway (LMA) does not have an inflatable cuff that prevents gastric insufflation like the Combi-tube. D: Nasotracheal intubation involves passing a tube through the nose into the trachea and is not the most appropriate choice in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Sodium bicarbonate and calcium chloride. During cardiac arrest, the priority is to correct any metabolic acidosis (sodium bicarbonate) and replenish calcium stores (calcium chloride) to support myocardial function. Sodium bicarbonate helps with acid-base balance, while calcium chloride is crucial for cardiac muscle contraction. Choice A is incorrect as magnesium sulfate alone is not sufficient for cardiac arrest. Choice B is incorrect as amiodarone is used for arrhythmias, not asystole. Choice D is incorrect as administering potassium during cardiac arrest can worsen the situation, and dopamine is not recommended in this scenario.

Correct Answer: D

Rationale: The correct answer is D because spinal cord injury can exist without visible fractures on x-rays. Objective findings may not be present initially, making it imperative to consider further evaluation beyond imaging studies. Central cord syndrome (choice A) typically presents with specific symptoms such as motor weakness in the upper extremities, which may not align with the given scenario. While MRI (choice B) is valuable for detailed soft tissue evaluation, it may not always be necessary for diagnosis. CT scan (choice C) is useful for visualizing bony structures but may not capture subtle spinal cord injuries. Thus, choice D is the most appropriate as it emphasizes the importance of clinical assessment and the possibility of spinal cord injury without immediate radiographic evidence.

Correct Answer: D

Rationale: Step 1: Diaphragmatic breathing in an unconscious patient who has fallen indicates injury to the spine. Step 2: Diaphragmatic breathing occurs when the spinal cord is damaged at a higher level, affecting the phrenic nerve. Step 3: This is a reliable clinical sign of spinal cord injury that requires immediate medical attention. Summary: A: Incorrect. A normal lateral c-spine film does not definitively exclude injury as soft tissue injuries may not be visible. B: Incorrect. Vertebral injuries can occur without immediate signs of cord injury due to the protective nature of the spinal cord. C: Incorrect. Immobilization on a short spine board is not always necessary and should be based on clinical assessment.

Correct Answer: D

Rationale: The correct answer is D because immobilization is crucial until a spinal fracture is ruled out by X-ray to prevent exacerbating a potential injury. A) Completing the neurologic exam is important but not sufficient to ensure spinal stability. B) Transfer to definitive care is essential but does not guarantee spinal fracture exclusion. C) Patient's ability to indicate no neck pain does not confirm absence of spinal injury.