ABA Emergency Response Procedures 4

Question 1

A patient develops pulseless electrical activity (PEA) intraoperatively. Which mnemonic summarizes the reversible causes to address immediately?

Accepted Answer

5Hs and 5Ts (Hypovolemia, Hypoxia, Hydrogen ion, Hypo/hyperkalemia, Hypothermia; Tension pneumothorax, Tamponade, Toxins, Thrombosis pulmonary, Thrombosis coronary)

Answer

SAMPLE (Signs, Allergies, Medications, Past history, Last meal, Events)

Answer

AVPU (Alert, Voice, Pain, Unresponsive)

Answer

DOPE (Displaced tube, Obstruction, Pneumothorax, Equipment failure)

Question 2

During a laparoscopic procedure, end-tidal CO2 abruptly rises to 80 mmHg and SpO2 drops to 78% with decreased breath sounds on the left. The MOST likely cause is:

Accepted Answer

Pneumothorax from trocar injury

Answer

Capnoperitoneum causing diaphragmatic pressure

Answer

Right mainstem intubation from the Trendelenburg position

Answer

CO2 subcutaneous emphysema

Question 3

A patient receiving a blood transfusion develops fever, chills, flank pain, and hemoglobinuria 15 minutes into the transfusion. What is the FIRST step?

Accepted Answer

Stop the transfusion immediately and maintain IV access with normal saline

Answer

Administer diphenhydramine 50 mg IV and slow the transfusion

Answer

Administer furosemide 40 mg IV to protect the kidneys

Answer

Send a stat type and crossmatch for a new unit

Question 4

After induction with succinylcholine, a patient's potassium rises from 4.2 to 7.8 mEq/L causing tall peaked T-waves. Which patient population is at highest risk for this hyperkalemic response?

Accepted Answer

Patients with burn injury more than 48 hours old or denervation injuries

Answer

Patients with end-stage renal disease on hemodialysis

Answer

Patients with diabetes mellitus on insulin therapy

Answer

Patients with chronic obstructive pulmonary disease

Question 5

During a carotid endarterectomy under general anesthesia, the patient suddenly develops ST-segment elevation in leads II, III, and aVF. The most appropriate immediate action is:

Accepted Answer

Notify the surgeon to abort the procedure; optimize coronary perfusion pressure

Answer

Administer nitroglycerin 100 mcg IV bolus

Answer

Increase the volatile agent to prevent awareness

Answer

Administer heparin 5,000 units IV

Question 6

A patient undergoing posterior fossa surgery in the sitting position develops sudden hypotension, a drop in ETCO2, and a characteristic sound on precordial Doppler. What is the MOST specific monitoring finding for venous air embolism?

Accepted Answer

Mill-wheel murmur on precordial Doppler

Answer

Decrease in pulse oximetry saturation

Answer

Rise in pulmonary artery pressure on PA catheter

Answer

ST-segment changes on ECG

Question 7

Intraoperatively, a patient's arterial line waveform shows pulsus paradoxus greater than 15 mmHg and CVP is elevated at 22 mmHg. The most likely diagnosis is:

Accepted Answer

Cardiac tamponade

Answer

Tension pneumothorax

Answer

Right ventricular failure

Answer

Superior vena cava syndrome