Your adult patient is experiencing a prolonged episode of paroxysmal supraventricular tachycardia but remains stable at the present time. He denies chest pain, shortness of breath, and his skin is warm and dry. He has failed to convert to a normal sinus rhythm after receiving the max dosage of adenosine in succession. What is your next step?

Correct Answer: B

Rationale: Step 1: Assess the situation - Patient is currently stable without any concerning symptoms. Step 2: Review previous treatment - Patient failed to convert with max dosage of adenosine. Step 3: Choose the next appropriate medication - Procainamide is recommended for stable patients with ongoing SVT not responding to adenosine. Step 4: Administer procainamide - It is effective in converting SVT and has a longer duration of action compared to adenosine. Summary: A: Verapamil is contraindicated in patients with stable SVT as it can cause hypotension. C: While expert consultation is valuable, immediate action is needed to manage the ongoing SVT. D: Administering Adenocard again is not recommended as it has already been tried at max dosage.

Correct Answer: E

Rationale: Step 1: The CHARTE method includes components: Chief complaint, History, Assessment, Rx (treatment), Transport, and Evaluation. Step 2: Each letter in CHARTE represents a key component of the patient care report. Step 3: "Transport" is a component in the CHARTE method, ensuring patients are safely transported to the appropriate facility. Step 4: Therefore, "Transport" is a part of the CHARTE method. This makes option A incorrect. Step 5: As "Transport" is a component, the correct answer is E: Chief complaint, which is not part of the CHARTE method.

Correct Answer: B

Rationale: The correct answer is B: Attach capnography to determine the presence of ventilatory waveform. This is the first tube placement confirmation to assess because it provides immediate feedback on proper endotracheal tube placement by showing a waveform indicating exhaled CO2. This confirms the tube is in the trachea and not the esophagus. Auscultating lung fields (A) only confirms air entry but not tube placement. An end-tidal CO2 detector (C) provides immediate confirmation like capnography but does not show the waveform for visualization. Auscultating over the epigastric region (D) is not a reliable method for confirming tube placement.

Correct Answer: A

Rationale: The correct answer is A: a laparotomy. This is the most appropriate step because a rifle wound to the mid-abdomen is a high-energy injury that can cause significant internal damage, such as bowel perforation or major blood vessel injury. A laparotomy allows for direct visualization of internal organs, identification, and repair of any injuries, and control of bleeding. An abdominal CT-scan (B) may delay necessary surgical intervention, while diagnostic laparoscopy (C) may not provide adequate access for effective treatment of severe injuries. Abdominal ultrasonography (D) is not typically indicated in the acute trauma setting for assessing internal abdominal injuries.

Correct Answer: A

Rationale: The correct answer is A: Mediastinal emphysema. In aortic rupture, air can leak into the mediastinum causing mediastinal emphysema. This suggests aortic injury. Choices B, C, and D are actually signs of aortic rupture. A "pleural cap" is seen in aortic rupture due to hemorrhage dissecting into the pleura. Obliteration of the aortic knob occurs due to aortic injury, and tracheal deviation to the right can occur due to a large hematoma pushing the trachea.