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A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are easily assisted with a
bag-mask device. It becomes more difficult to ventilate the patient over the next
5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to
89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. - CORRECT ANSWER-A.
Obtain a chest x-ray
A 30-year-old man sustains a severely comminuted, open, distal right femur
fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation
is present over the lateral aspect of the foot but decreased over the medial foot
,and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior
tibial pulses are easily palpable on the left, but heard only by Doppler on the right.
Immediate efforts to improve circulation to the injured extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity - CORRECT
ANSWER-B. Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED
following a crash. He had decreased level of consciousness at the scene, but then
was alert and conversational during transportation. Now his GCS is only 11. Which
of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma - CORRECT ANSWER-
E. The patient probably has an acute epidural hematoma
,Which of the following is the recommended Method for treatment frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer - CORRECT ANSWER-C. Warm (40
degrees) water
Which of the following physical findings suggest a cause of hypotension other
than spinal cord injury?
A. Priapism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them - CORRECT ANSWER-D.
Presence of deep tendon reflexes. Spinal shock refers to loss of muscle toe
(flaccidty) and loss of reflexes.
The primary indication for transferring A patient to a higher level trauma center
is:
, A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma - CORRECT
ANSWER-C. Resource limitations as determined by the transferring doctor
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated
without improvement in his vital signs. The next, most appropriate, step is to
perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage - CORRECT ANSWER-A. Laparotomy because
of hemodynamic abnormality
A 42-year-old man is trapped from the waist down beneath his overturned tractor
for several hours before medical assistance arrives. He is awake and alert until