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Ventricular fibrillation persists through three defibrillation attempts, each separated by 2 minutes of high-quality CPR. Compressions have resumed after the third shock. Epinephrine 1 mg IV was given 90 seconds ago, and no antiarrhythmic has been administered. Which medication should be added during this CPR cycle?
Correct answer: B - Amiodarone 300 mg IV as a bolus
A 34-year-old woman describes palpitations that began abruptly while she was reading. Her rhythm is regular at 184/min with a QRS duration of 0.08 second. She is alert, BP is 126/78 mm Hg, and she has no chest discomfort or dyspnea. A modified Valsalva maneuver fails. With a functioning antecubital IV and no contraindication to adenosine, what is the appropriate initial treatment?
Correct answer: D - Adenosine 6 mg by rapid IV push, then a saline flush
An adult found beside an open opioid prescription bottle is unresponsive and apneic. A carotid pulse is definitely present at 64/min. One rescuer has opened the airway and has a bag-mask device ready; a second rescuer is obtaining naloxone. The immediate priority is to:
Correct answer: A - Provide one bag-mask breath every 6 seconds
Forty minutes after the onset of crushing chest pressure and diaphoresis, a 58-year-old man has 3-mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. The first high-sensitivity troponin is within the laboratory reference range. Aspirin has been given, and the hospital's catheterization team can provide prompt primary PCI. How should the normal troponin affect disposition?
Correct answer: A - Activate the catheterization laboratory for primary PCI
Transcutaneous pacing is started for complete AV block with hypotension after atropine is ineffective. Each pacing spike is followed by a wide QRS complex, and the patient's chest muscles twitch at the programmed rate of 70/min. Which additional observation demonstrates mechanical capture?
Correct answer: C - Arterial upstrokes follow each paced QRS, with BP 108/64 mm Hg
At 08:40, a woman finds her 72-year-old husband unable to hold his coffee cup in his right hand. She last saw him functioning normally at 07:15. EMS finds reduced movement of the right side of his face when he smiles, right arm drift during the 10-second arm test, and clear, accurate sentence repetition. Glucose is 112 mg/dL, and these deficits are new. For the Cincinnati Prehospital Stroke Scale and the prearrival stroke alert, the correct report is:
Correct answer: B - Positive screen with two abnormal findings; last known well 07:15
A patient with ongoing hematemesis becomes pale and confused as BP falls to 78/44 mm Hg. Telemetry shows the heart rate rising gradually from 108 to 146/min. Every narrow QRS is preceded by an upright P wave in lead II, with a constant PR interval. Another clinician proposes cardioversion because the patient is hypotensive and tachycardic. Which response best addresses the cause of deterioration?
Correct answer: D - Restore circulating volume and control bleeding
The monitor shows an organized narrow-complex rhythm at 38/min in an unresponsive, apneic adult. No carotid pulse is identified within 10 seconds. CPR and bag-mask ventilation are underway, and a patent IV is available. No resuscitation medication has been given. Select the order that belongs to this treatment pathway.
Correct answer: C - Epinephrine 1 mg IV immediately
After return of spontaneous circulation, an intubated patient remains unresponsive to commands. On an inspired oxygen fraction of 1.0, a reliable pulse-oximetry waveform shows SpO2 100%. Arterial blood gas results are PaO2 278 mm Hg and PaCO2 27 mm Hg; MAP is 76 mm Hg. There is no separate indication for therapeutic hyperventilation. Which ventilator adjustment addresses both abnormalities?
Correct answer: C - Reduce the oxygen fraction and reduce minute ventilation
A resuscitation review divides 5 minutes of ongoing cardiac arrest into 210 seconds of chest compressions, 60 seconds without compressions for airway placement, and 30 seconds of rhythm-check and shock pauses. During compressions, the rate was 112/min, depth 5.4 cm, and recoil complete. The team's chest-compression-fraction target is at least 80%. Which calculation and corrective action address the main quality deficit?
Correct answer: A - 70%; shorten hands-off intervals
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