Your adult hemodialysis patient is in cardiac arrest one hour after completing a dialysis treatment. He is found to be apneic and asystolic with adequate CPR in progress. Which of the following should be administered during the resuscitation attempt?

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 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.

Correct Answer: C

Rationale: The correct answer is C. In a stable patient without neck pain, neurological deficits, or midline tenderness, cervical spine x-rays are not necessary. This is because the clinical assessment is more reliable in ruling out cervical spine injury. Performing unnecessary x-rays exposes the patient to radiation without providing additional benefit. Additionally, immobilization in a hard collar and on a long spine board is already in place, and further imaging does not change the management in this scenario. Therefore, the most appropriate course of action is to rely on the clinical assessment criteria mentioned in choice C to guide management. Choices A, B, and D are incorrect because they do not align with current guidelines for cervical spine imaging in trauma patients.

Correct Answer: C

Rationale: Neurogenic shock is characterized by hypotension and vasodilatation due to loss of sympathetic tone. The narrowed pulse pressure is not a classic characteristic but rather a sign of cardiogenic shock. Neurologic deficit is common in neurogenic shock due to the underlying neurological injury. Therefore, choice C is incorrect as it does not align with the typical features of neurogenic shock.