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: The correct answer is B: Administer procainamide. Procainamide is a Class I antiarrhythmic medication that can be used for the management of stable paroxysmal supraventricular tachycardia (PSVT) when adenosine fails. Procainamide works by slowing conduction through the atrioventricular node and can help convert the patient to a normal sinus rhythm. Administering verapamil (Choice A) can be risky in patients with PSVT as it can potentially worsen the condition and cause hypotension. Obtaining expert consultation (Choice C) is always a good practice, but in this scenario, immediate intervention is needed. Administering Adenocard (Choice D) is not recommended as the patient has already received the max dosage of adenosine without converting to normal sinus rhythm.

Correct Answer: E

Rationale: The correct answer is E: Transport. In the CHARTE method, the components are Chief complaint, History, Assessment, Rx/Treatment, Transport, and Evaluation. Transport is not a component but rather a step in the patient care process. Chief complaint is the reason for the call, History is the patient's background, Assessment is the evaluation of the patient, Rx/Treatment is the actions taken, and Evaluation is the outcome. The other choices are incorrect because they are all integral components of the CHARTE method.

Correct Answer: B

Rationale: The correct answer is B: Attach capnography to determine the presence of ventilatory waveform. Capnography provides immediate feedback on the effectiveness of ventilation, crucial in assessing tube placement. First, confirm if CO2 waveform is present, indicating proper tube placement in the trachea. If waveform absent, reposition tube. Auscultation (Choice A) may not accurately confirm tracheal intubation. End-tidal CO2 detector (Choice C) is efficient but not the first step. Auscultating over the epigastric region (Choice D) is inappropriate for confirming tube placement.

Correct Answer: A

Rationale: The correct answer is A: a laparotomy. In trauma cases like this, immediate exploration of the abdomen via laparotomy is crucial to assess and control internal bleeding and injuries. It allows for direct visualization and repair of damaged structures, which is essential in life-threatening situations. Abdominal CT-scan (B) may provide detailed imaging but can delay necessary surgical intervention. Diagnostic laparoscopy (C) may not be suitable for unstable patients with significant trauma. Abdominal ultrasonography (D) may not provide sufficient information in cases of penetrating abdominal trauma.

Correct Answer: A

Rationale: The correct answer is A: Mediastinal emphysema. Aortic rupture typically presents with signs like presence of a "pleural cap," obliteration of the aortic knob, and deviation of the trachea to the right. Mediastinal emphysema is not a specific sign of aortic rupture but rather indicates air in the mediastinum, often seen in esophageal rupture or pneumomediastinum. Therefore, in the context of a blunt trauma victim, the presence of mediastinal emphysema is less suggestive of aortic rupture compared to the other signs listed.