A 22-year-old man is hypotensive and tachycardic a er a shotgun wound to the le shoulder.
His blood pressure is ini ally 80/40 mm Hg. A er ini al fluid resuscita on 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 le chest breath
sounds with the return of a small amount of blood and no air leak. A er chest tube inser on,
the most appropriate next step is: -correct answers re-examine the chest
A construc on 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: -correct answers complete
spine x-ray series
Which of the following is true regarding the ini al resuscita on of a trauma pa ent? -correct
answers Evidence of improved perfusion a er fluid resuscita on could include improvement in
Glasgow Coma Scale score on reevalua on.
In managing a pa ent with a severe trauma c brain injury, the most important ini al step is to: -
correct answers secure the airway
A previously healthy, 70-kg (154-pound) man suffers an es mated acute blood loss of 2 liters.
Which one of the following statements applies to this pa ent? -correct answers An ABG would
demonstrate a base deficit between -6 and -10 mEq/L.
,The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by: -correct answers increasing the volume of blood loss to
produce maternal hypotension
The best assessment of fluid resuscita on of the adult burn pa ent is: -correct answers urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: -correct answers evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes a er
he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh.
Immediate management of the wound should consist of: -correct answers direct pressure on
the wound
For the pa ent with severe trauma c brain injury, profound hypocarbia should be avoided to
prevent: -correct answers cerebral vasoconstric on with diminished perfusion
A er being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabili es available.. Computed tomography of the chest and abdomen shows an
aor c injury and splenic lacera on with free abdominal fluid. His blood pressure falls to 70 mm
Hg a er CT. The next step is: -correct answers perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant pa ent is
TRUE? -correct answers Leakage of amnio c fluid is an indica on for hospital admission.
The first maneuver to improve oxygena on a er chest injury is: -correct answers administer
supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admi ed to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not follow
,commands, but he does moan periodically. His right arm is deformed and does not respond to
pressure; however, his le hand reaches purposefully toward the s mulus. Both legs are s ffly
extended. His GCS score is: -correct answers 9
A 20-year-old woman who is at 32 weeks gesta on, is stabbed in the upper right chest. In the
emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath,
extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The
most appropriate first step is to: -correct answers perform needle or finger decompression of
the right chest
Which one of the following findings in an adult is most likely to require immediate management
during the primary survey? -correct answers respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: -correct
answers placement of an occlusive dressing over the wound
The following are contraindica ons for tetanus toxoid administra on: -correct answers history
of neurological reac on or severe hypersensi vity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the emergency department he is diaphore c and complaining of
chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute.
Which of the following best differen ates cardiac tamponade from tension pneumothorax as
the cause of his hypotension? -correct answers breath sounds
Bronchial intuba on of the right or le mainstem bronchus can easily occur during infant
endotracheal intuba on because: -correct answers The trachea is rela vely short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an alterca on and is
brought by ambulance to a hospital that has full surgical capabili es. His wounds are all above
the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid
, resuscita on is ini ated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal
injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and
respiratory rate is 14 breaths per minute (ven lated with 100% O2). 1500 mL of blood has
drained from the right chest. The most appropriate next step in managing this pa ent is to: -
correct answers urgently transfer the pa ent to the opera ng room
A 39-year-old man is admi ed to the emergency department a er an automobile collision. He is
cyano c, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it
difficult to fit the oxygen facemask to his face. The most appropriate next step is to: -correct
answers restrict cervical mo on and a empt orotracheal intuba on using 2 people
A pa ent is brought to the emergency department a er a motor vehicle crash. He is conscious
and there is no obvious external trauma. He arrives at the hospital completely immobilized on a
long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute.
His skin is warm. Which one of the following statements is TRUE? -correct answers Flaccidity of
the lower extremi es and loss of deep tendon reflexes are expected.
Which one of the following is the most effec ve method for ini ally trea ng frostbite? -correct
answers moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he
is extricated. On arrival in the emergency department, his right lower extremity is cool, mo led,
insensate, and mo onless. Despite normal vital signs, pulses cannot be palpated below the right
femoral artery and the muscles of the lower extremity are firm and hard. During the
management of this pa ent, which of the following is most likely to improve the chances for
limb salvage? -correct answers surgical consulta on for right lower extremity fasciotomy
A pa ent arrives in the emergency department a er being beaten about the head and face with
a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen
and ecchymo c. He has gurgling respira ons and vomitus on his face and clothing. The most
appropriate step a er providing supplemental oxygen and eleva ng his jaw is to: -correct
answers suc on the oropharynx
His blood pressure is ini ally 80/40 mm Hg. A er ini al fluid resuscita on 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 le chest breath
sounds with the return of a small amount of blood and no air leak. A er chest tube inser on,
the most appropriate next step is: -correct answers re-examine the chest
A construc on 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: -correct answers complete
spine x-ray series
Which of the following is true regarding the ini al resuscita on of a trauma pa ent? -correct
answers Evidence of improved perfusion a er fluid resuscita on could include improvement in
Glasgow Coma Scale score on reevalua on.
In managing a pa ent with a severe trauma c brain injury, the most important ini al step is to: -
correct answers secure the airway
A previously healthy, 70-kg (154-pound) man suffers an es mated acute blood loss of 2 liters.
Which one of the following statements applies to this pa ent? -correct answers An ABG would
demonstrate a base deficit between -6 and -10 mEq/L.
,The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by: -correct answers increasing the volume of blood loss to
produce maternal hypotension
The best assessment of fluid resuscita on of the adult burn pa ent is: -correct answers urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: -correct answers evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes a er
he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh.
Immediate management of the wound should consist of: -correct answers direct pressure on
the wound
For the pa ent with severe trauma c brain injury, profound hypocarbia should be avoided to
prevent: -correct answers cerebral vasoconstric on with diminished perfusion
A er being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabili es available.. Computed tomography of the chest and abdomen shows an
aor c injury and splenic lacera on with free abdominal fluid. His blood pressure falls to 70 mm
Hg a er CT. The next step is: -correct answers perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant pa ent is
TRUE? -correct answers Leakage of amnio c fluid is an indica on for hospital admission.
The first maneuver to improve oxygena on a er chest injury is: -correct answers administer
supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admi ed to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not follow
,commands, but he does moan periodically. His right arm is deformed and does not respond to
pressure; however, his le hand reaches purposefully toward the s mulus. Both legs are s ffly
extended. His GCS score is: -correct answers 9
A 20-year-old woman who is at 32 weeks gesta on, is stabbed in the upper right chest. In the
emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath,
extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The
most appropriate first step is to: -correct answers perform needle or finger decompression of
the right chest
Which one of the following findings in an adult is most likely to require immediate management
during the primary survey? -correct answers respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: -correct
answers placement of an occlusive dressing over the wound
The following are contraindica ons for tetanus toxoid administra on: -correct answers history
of neurological reac on or severe hypersensi vity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the emergency department he is diaphore c and complaining of
chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute.
Which of the following best differen ates cardiac tamponade from tension pneumothorax as
the cause of his hypotension? -correct answers breath sounds
Bronchial intuba on of the right or le mainstem bronchus can easily occur during infant
endotracheal intuba on because: -correct answers The trachea is rela vely short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an alterca on and is
brought by ambulance to a hospital that has full surgical capabili es. His wounds are all above
the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid
, resuscita on is ini ated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal
injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and
respiratory rate is 14 breaths per minute (ven lated with 100% O2). 1500 mL of blood has
drained from the right chest. The most appropriate next step in managing this pa ent is to: -
correct answers urgently transfer the pa ent to the opera ng room
A 39-year-old man is admi ed to the emergency department a er an automobile collision. He is
cyano c, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it
difficult to fit the oxygen facemask to his face. The most appropriate next step is to: -correct
answers restrict cervical mo on and a empt orotracheal intuba on using 2 people
A pa ent is brought to the emergency department a er a motor vehicle crash. He is conscious
and there is no obvious external trauma. He arrives at the hospital completely immobilized on a
long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute.
His skin is warm. Which one of the following statements is TRUE? -correct answers Flaccidity of
the lower extremi es and loss of deep tendon reflexes are expected.
Which one of the following is the most effec ve method for ini ally trea ng frostbite? -correct
answers moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he
is extricated. On arrival in the emergency department, his right lower extremity is cool, mo led,
insensate, and mo onless. Despite normal vital signs, pulses cannot be palpated below the right
femoral artery and the muscles of the lower extremity are firm and hard. During the
management of this pa ent, which of the following is most likely to improve the chances for
limb salvage? -correct answers surgical consulta on for right lower extremity fasciotomy
A pa ent arrives in the emergency department a er being beaten about the head and face with
a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen
and ecchymo c. He has gurgling respira ons and vomitus on his face and clothing. The most
appropriate step a er providing supplemental oxygen and eleva ng his jaw is to: -correct
answers suc on the oropharynx
