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1. re-examine the chest A 22-year-old man is hy-
potensive and tachycardic
after a shotgun wound
to the left shoulder. His
blood pressure is initial-
ly 80/40 mm Hg. Af-
ter initial fluid resuscita-
tion 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.
A tube thoracostomy is
performed for decreased
left chest breath sounds
with the return of a small
amount of blood and no
air leak. After chest tube
insertion, the most appro-
priate next step is:
2. complete spine x-ray series A construction worker falls
two stories from a build-
ing and sustains bilater-
al calcaneal fractures. In
the emergency depart-
ment, he is alert, vital
signs are normal, and he
is complaining of severe
pain in both heels and his
lower back. Lower extrem-
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ity pulses are strong and
there is no other deformi-
ty. The suspected diagno-
sis is most likely to be con-
firmed by:
3. Evidence of improved perfusion after fluid resusci- Which of the following is
tation could include improvement in Glasgow Coma true regarding the initial
Scale score on reevaluation. resuscitation of a trauma
patient?
4. secure the airway In managing a patient
with a severe traumatic
brain injury, the most im-
portant initial step is to:
5. An ABG would demonstrate a base deficit between -6 A previously healthy, 70-kg
and -10 mEq/L. (154-pound) man suffers
an estimated acute blood
loss of 2 liters. Which
one of the following state-
ments applies to this pa-
tient?
6. increasing the volume of blood loss to produce mater- The physiological hyperv-
nal hypotension olemia of pregnancy has
clinical significance in
the management of the
severely injured, gravid
woman by:
7. urinary output of 0.5 mL/kg/hr
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The best assessment of
fluid resuscitation of the
adult burn patient is:
8. evidence of inadequate organ perfusion The diagnosis of shock
must include:
9. direct pressure on the wound A 7-year-old boy is
brought to the emergency
department by his parents
several minutes after he
fell through a window. He
is bleeding profusely from
a 6-cm wound of his me-
dial right thigh. Immedi-
ate management of the
wound should consist of:
10. cerebral vasoconstriction with diminished perfusion For the patient with se-
vere traumatic brain in-
jury, profound hypocarbia
should be avoided to pre-
vent:
11. perform an exploratory laparotomy After being involved in
a motor vehicle crash,
a 25-year-old man is
brought to a hospital that
has surgery capabilities
available.. Computed to-
mography of the chest
and abdomen shows an
aortic injury and splenic
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laceration with free ab-
dominal fluid. His blood
pressure falls to 70 mm Hg
after CT. The next step is:
12. Leakage of amniotic fluid is an indication for hospital Which one of the follow-
admission. ing statements regarding
abdominal trauma in the
pregnant patient is TRUE?
13. administer supplemental oxygen The first maneuver to im-
prove oxygenation after
chest injury is:
14. 9 A 25-year-old man, in-
jured in a motor ve-
hicular crash, is admit-
ted to the emergency de-
partment. His pupils re-
act sluggishly and his eyes
open to pressure. He does
not follow commands, but
he does moan periodical-
ly. His right arm is de-
formed and does not re-
spond to pressure; how-
ever, his left hand reach-
es purposefully toward the
stimulus. Both legs are
stiffly extended. His GCS
score is:
15.