Your adult patient is experiencing lightheadedness and shortness of breath. He is found to be bradycardic with a second-degree type II AV heart block on the electrocardiogram. His heart rate is 44, he is breathing 20 times per minute, and has a blood pressure of 90 systolic. He is cool and pale but denies chest pain. Which of the following would be most appropriate if the patient fails to respond to atropine?

Correct Answer: C

Rationale: The correct answer is C: Transcutaneous pacing. In this scenario of a patient with bradycardia and a second-degree type II AV block, transcutaneous pacing is the most appropriate next step if the patient fails to respond to atropine. Transcutaneous pacing involves placing external electrodes on the patient's chest to deliver electrical impulses to stimulate the heart, effectively pacing the heart and maintaining an adequate heart rate. This is crucial in a patient with symptomatic bradycardia and heart blocks as it can quickly and effectively increase the heart rate and improve cardiac output. The other choices are incorrect: A: Administering 1 milligram of epinephrine may be too aggressive and can further worsen the heart block in this case. B: Synchronized cardioversion at 10 joules is not indicated for bradycardia and can be harmful in this scenario. D: Administering a 500-milliliter IV bolus of normal

Correct Answer: B

Rationale: The correct answer is B: "Prevent secondary brain injury." In managing severe head injury with a GCS of 6, preventing secondary brain injury is crucial. Lowering intracranial pressure and optimizing cerebral perfusion are essential to prevent further damage. Administering an osmotic diuretic (A) may be considered but is not the priority in this scenario. Aggressively treating systemic hypertension (C) can potentially worsen cerebral perfusion. Reducing metabolic requirements of the brain (D) is important but not as immediate as preventing secondary brain injury.

Correct Answer: B

Rationale: The correct answer is B because aspiration of bone marrow confirms appropriate needle positioning in intraosseous infusion. This step ensures that the needle is within the medullary space, allowing for safe and effective administration of fluids or medications. Option A is incorrect because various fluids, including blood products and medications, can be infused via intraosseous route. Option C is incorrect as intravenous access is preferred over intraosseous in small children. Option D is incorrect since intraosseous infusion is a temporary measure until vascular access is established.

Correct Answer: A

Rationale: The correct answer is "Moist heat" for treating frostbite. Moist heat helps to gradually warm the affected area, promoting blood flow and reducing tissue damage. This method is recommended because sudden temperature changes can worsen the condition. Choice B, early amputation, is incorrect as it is an extreme measure and should only be considered as a last resort in severe cases where tissue has already died. Choice C, padding and elevation, can help reduce swelling and promote circulation but may not be sufficient as the sole treatment for frostbite. Choice D, vasodilators and heparin, are not typically used in the initial treatment of frostbite. While vasodilators may help improve blood flow, they are not the primary recommended method for treating frostbite.

Correct Answer: C

Rationale: The correct answer is C: Chest x-ray. Before transferring the patient for neurosurgical care, a chest x-ray is mandatory to assess for any potential thoracic injuries that may impact respiratory function during transport. This is crucial to ensure the patient's stability and prevent any complications. Choice A, FAST exam, is typically used to evaluate for intra-abdominal injuries and is not directly related to the patient's immediate need for neurosurgical care. Choice B, Lateral cervical spine x-ray, may be important for assessing cervical spine injuries, but in this scenario, the patient is already in full spinal protection and the priority is to address potential thoracic injuries that could affect respiratory function. Choice D, Administration of methylprednisolone, is not indicated as a mandatory step prior to transport for neurosurgical care. While it may be considered as part of the treatment plan later on, it is not an immediate requirement for safe transport in this case.