An EKG shows ventricular tachycardia in a patient with a heart rate of 160 bpm and a blood pressure of 90/60 mmHg. The best initial therapeutic maneuver prior to cardioversion is
(A) causes more hemodynamic stimulation than an oropharyngeal airway
(B) is contraindicated in patients with cervical spine instability
(C) is more easily inserted when cricoid pressure is applied
(D) may serve as a temporary airway in case of a failed rapid sequence intubation
(E) requires administration of a muscle relaxant to avoid laryngospasm during insertion
D
Postoperatively, a patient is being mechanically ventilated by a constant-flow, pressure-cycled ventilator with the following initial settings: inspiratory/expiratory (I/E) ratio of 1:2, peak inspiratory pressure (PIP) of 25 cmH2O, and rate of 10/min. One hour later, the I/E ratio is 1:4. Which of the following would ensure that the minute ventilation is the same as that initially set?
(A) Inflate the endotracheal tube cuff to prevent leakage
(B) Double the respiratory rate
(C) Decrease the expiratory pause until the I/E ratio is 1.0
A 70-kg patient experiences pain on incision of a thigh abscess. The area around the abscess had been infiltrated with 30 ml of 1% lidocaine in 1:200,000 epinephrine. The local anesthetic was most likely ineffective because of
(A) acidosis at the site of the injection
(B) epinephrine-induced limitation of drug diffusion
A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the following drugs?
A 55-year-old woman who is scheduled to undergo carotid endarterectomy has a history of essential hypertension and chronic obstructive pulmonary disease. Over a 30-minute period beginning one hour after induction of general anesthesia, Sp02 decreases from 99% to 95%. During that time, she has received fentanyl 100 mcg, isoflurane 1%, nitrous oxide 49.5%, oxygen 49.5%, and a nitroglycerin infusion to maintain blood pressure at approximately 160/95 mmHg. Which of the following is the most likely cause for the decline in oxygen saturation?
(A) Decreased cardiac output
(B) Increased dead space ventilation
(C) Inhibition of hypoxic pulmonary vasoconstriction
A 28-year-old patient has severe laryngospasm after extubation of the trachea following general anesthesia. Administration of 100% oxygen using continuous positive airway pressure does not improve symptoms. SpO2 is 75%. Which of the following is the most appropriate immediate management?