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. This airway adjunct has a large distal end with an inflatable cuff that presses against the patient's esophageal sphincter. The proximal border rests against the tongue, effectively sealing the esophagus and allowing for positive pressure ventilations to be delivered to the trachea. The King LTD airway (A) is a supraglottic airway device used for ventilation but does not press against the esophageal sphincter. The Laryngeal Mask Airway (LMA) (C) sits above the glottis and does not have a distal cuff to seal the esophagus. Nasotracheal intubation (D) involves passing a tube through the nose into the trachea and does not involve a cuff pressing against the esophageal sphincter.

Correct Answer: C

Rationale: The correct answer is C: Sodium bicarbonate and calcium chloride. During cardiac arrest, the priority is to correct metabolic acidosis and provide adequate calcium for cardiac function. Sodium bicarbonate helps in correcting metabolic acidosis, while calcium chloride supports cardiac contractility. A: Sodium bicarbonate and magnesium sulfate - Magnesium sulfate is not indicated during cardiac arrest, and sodium bicarbonate alone may not address the calcium needs for cardiac function. B: Amiodarone and magnesium sulfate - Amiodarone is used for ventricular arrhythmias, not for asystole, and magnesium sulfate is not the priority in this scenario. D: Potassium and dopamine - Potassium can exacerbate the situation, and dopamine is not recommended as a first-line drug during cardiac arrest. In summary, the correct answer provides the necessary interventions to address metabolic acidosis and support cardiac function during the resuscitation attempt.

Correct Answer: D

Rationale: The correct answer is D because spinal cord injuries can sometimes exist without visible fractures on x-ray studies. It is important to consider the possibility of spinal cord injury even in the absence of objective findings on x-ray. This is because spinal cord injuries can result from trauma that does not necessarily cause bony damage. Therefore, relying solely on x-ray studies to diagnose spinal cord injury may lead to missed or delayed diagnosis. Options A, B, and C are incorrect because central cord syndrome, MRI, and CT-scan are not definitive for ruling out spinal cord injury in the absence of visible fractures.

Correct Answer: D

Rationale: The correct answer is D because diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury. This is due to the fact that unconscious patients rely on their diaphragm for breathing rather than their chest muscles, indicating potential spinal cord trauma affecting the chest muscles' innervation. A: A normal lateral c-spine film does not completely exclude injury, as some injuries may not be visible on imaging. B: Vertebral injury can occur without immediate physical findings of a cord injury. C: Immobilization on a short spine board may not be necessary for all patients with suspected spinal injury, as it depends on individual assessment.

Correct Answer: D

Rationale: The correct answer is D because before removing immobilization, it is crucial to confirm the absence of a spinal fracture through x-ray. This ensures that any potential spinal injury is not worsened during movement. A is incorrect because the neurologic exam alone is not sufficient to determine spinal stability. B is incorrect as definitive care may not involve immediate removal of immobilization. C is incorrect as the ability to indicate no neck pain does not rule out a spinal fracture.