SAEM Exam with Questions and Verified Solutions

SAEM Exam with Questions and Verified Solutions An 18 year old male is transported to the emergency department after being involved in a motor vehicle collision. On initial evaluation, he is found to be comatose, hypotensive, and is diagnosed clinically as having a tension pneumothorax on the left side. What is the correct statement regarding needle decompression or chest tube placement in this patient? A. Placement of the needle should be in the 3rd ICS, midaxillary line. B. An 18 French chest tube would be appropriate in this situation. C. A chest x-ray is unnecessary before needle decompression D. The chest tube should be inserted under the lower edge of the rib ANSWER C.. A chest x-ray is unnecessary before needle decompression The answer is C. In an unstable patient such as this, a chest x-ray would delay the care of this patient and is unnecessary. This patient needs immediate intervention with needle decompression. A chest tube size of #28 French or greater would be indicated since this patient may have a hemothorax (B). Needle decompression involves placement of a #14 gauge needle in the 2nd intercostal space at the midclavicular line (C). The chest tube should be inserted over the upper border of the rib to avoid the neurovascular bundle at the inferior margin of each rib. The Figure depicts a patient with toe pain. She does not recollect any trauma. Regarding the Figure and her presentation, which of the following is true? [image shows big swollen white pocket next to toe nail of big toe] A. This patient can be managed with a simple surgical procedure, with no need for outpatient medications other than analgesics B. The cellulitis in the toe is the primary problem C. Occult trauma and fracture are the most likely diagnoses, and the patient will probably require splinting after X-ray