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A 22-year-old man is hypotensive and tachycardic after a shotgun wound
to the left shoulder. His blood pressure is initially 80/40 mm Hg. After 2
liters of crystalloid solution his blood pressure increases to 122/84 mm
Hg. His heart rate is now 100 beats per minute and his respiratory rate is
28 breaths per minute. His breath sounds are decreased in the left
hemithorax, and after initial IV fluid resuscitation, a closed tube
thoracostomy is performed for decreased left breath sounds with the return
of a small amount of blood and no air leak. After chest tube insertion, the
most appropriate next step is:
a) reexamine the chest.
b) perform an aortogram.
c) obtain a CT scan of the chest.
d) obtain arterial blood gas analyses - CORRECT ANSWER>>: a)
reexamine the chest
Which one of the following physical findings suggests a cause of
,hypotension other than spinal cord injury?
,a) priapism.
b) bradycardia.
c) diaphragmatic breathing.
d) presence of deep tendon reflexes. - CORRECT ANSWER>>: d)
presence of deep tendon reflexes.
A construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert, vital
signs are normal, and he is complaining of severe pain in both heels and
his lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by:
a) compartment pressures
b) retrograde urethrogram
c) Doppler-ultrasound studies
d) complete spine x-ray series - CORRECT ANSWER>>: d)
complete spine x-ray series
In managing the head-injured patient, the most important initial step is to:
, a) obtain c-spine film.
b) secure the airway.
c) support the circulation.
d) control scalp hemorrhage. - CORRECT ANSWER>>: b) secure the
airway.
A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to this
patient?
a) His pulse pressure will be widened.
b) His urinary output will be at the lower limits of normal.
c) He will have tachycardia, but no change in his systolic blood
pressure.
d) His systolic blood pressure will be decreased with a narrowed pulse
pressure. - CORRECT ANSWER>>: d) His systolic blood pressure will
be decreased with a narrowed pulse pressure.
The physiologic hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by:
a) reducing the need for blood transfusion.
b) increasing the risk of pulmonary edema.