1. The primary indication for transferring a
a a a a a a 4. Which one of the following st
a a a a a a
a patient to a higher level trauma center is:
a a a a a a a g patients with thoracic spine inj
a a a a a
unavailabilityaofaaasurgeonaoraoperatingarooma diaphra
staff.amult
ipleasystemainjuries,aincludingaseverea na depresseda skull
headainjury.
resourcealimitationsaasadeterminedabyathea tureaofath
transferringadoctor.
resourcealimitationsaasadeterminedabyathea tureaofa thea cribrifo
hospitalaadministration.awiden
edamediastinumaonachestax-raya
followingabluntathoracicatrauma.
2. teen-
aged bicycle rider is hit by a truck traveling at a
a a a a a a a a a a a
high rate of speed. In the emergency department
a a a a a a a
, she is actively bleedingfrom open fractures of h
a a a a a a a a a
er legs, and has abrasions on her chest and abdo
a a a a a a a a a
minal wall. Her a a
a blood pressure is 80/50 mm Hg, heart rate is140 b
a a a a a a a a a a
eats per minute, respiratory rate is 8
a a a a a a
a breaths per minute, and GCS score is 6. The
a a a a a a a a a
first step in managing this patient is to:
a a a a a a a
obtaina aa laterala cervicala spinea x-ray.
a ins
ertaaacentralavenousapressurealine.
a ad
ministera 2a litersa ofa crystalloida solution.
a per
formaendotrachealaintubationaand
, Log-rollingamayabeadestabilizingato aac
fracturesafromaT-12atoaL-1. ana abdo
Adequateaimmobilizationacanabe
accomplishedawithatheascoopastretcher. nost
SpinalacordainjuryabelowaT-10ausuallyaspares
bowelaandabladderafunction. minala ultraso
Hyperflexionafracturesainatheaupper aadiagnosticaperitone
thoracicaspineaareainherentlyaunstable.
Theseapatientsararelyapresentawithaspinal
6. youngawomanasustainsaaasever
shocka ina associationa witha corda injury.
the result of a motor vehicular cr
a a a a a a
gency department, her GCS scor
a a a a
5. youngamanasustainsaaaritleawoundatoatheamid- a blood pressure is 140/90 mm Hg
a a a a a
abdomen. He is brought promptly to the emerg
a a a a a a a a e is 80 beats per minute. She is in
a a a a a a a a
ency department by prehospital
a a a
ng mechanically ventilated. Her
a a a
a personnel. His skin is cool and diaphoretic, andhi
a a a a a a a a
n size and equally reactive to ligh
a a a a a a
s systolic blood pressure is 58 rnm Hg.
a a a a a a a
There is no other apparent injury
a a a a a
Warmed crystalloid fluids are initiated without i
a a a a a a
tant principle to follow in the ear
a a a a a a
mprovement in his vital signs. The next, mosta
a a a a a a a a
of her head injury is to:
a a a a a
ppropriate step is to perform:
a a a a
administeraanaosmotic
preventasecondaryabra
, aggressivelyatreatasystemicahypertension. 9. 8-year-
a
reduceametabolicarequirementsaofathe old girl is an unrestrained passe
a a a a a
brain.adis struck from behind. In the emerg a a a a a
tinguishabetweenaintracranialahematoma nt, her blood pressure is 80/60 m
a a a a a a
andacerebralaedema. is 80 beats per minute,and respi
a a a a a a a
breaths per minute. a a
Her GCS score is 14. She compla
a a a a a a
7. 22-year-
afeel "funny and won't move rig
a a a a a
old man is brought to the hospital after crashi
a a a a a a a a
er spine x-
a a
ng his motorcycle into a telephone
a a a a a
rays do not show a fracture or d
a a a a a a a
a pole. He is unconscious and in profound shock.H
a a a a a a a a
nal cord injury inthis child:
a a a a a
e has no open wounds or obvious fractures.
a a a a a a a
isa mosta likelya aa centrala corda sy
The cause of his shock is MOST LIKELYcause
a a a a a a a a
mustabeadiagnosedabyamagneticare
d by:
a
aasubduralahematoma.a a
canabeaexcludedabyaobtainingaaaC
anaepiduralahematoma.a a aa
en
transectedalumbaraspinalacord.a a aaat
mayaexistainatheaabsenceaofao
a
ransectedacervicalaspinalacord.a findingsaonax-ra
a
hemorrhageaintoatheachestaoraabdomen.a
isaunlikelyabecauseaofatheainc
calcificationaofatheavertebr
8. 30-year- a
old man is struck by a car traveling at 56 kph (35
a a a a a a a a a a a a
10. Immediateachestatubeainsertio
mph). He has obvious fractures ofthe left tibia n
a a a a a a a a a
or which of the following condit
a a a a a
ear the knee, pain in the pelvic area, and severe
P
a a a a a a a a a a
dyspnea. His heart rate is 180 a a a a a
beats per minute, and his respiratory rate is 48
mo
a a a a a a a a a
breaths per minute with no breath sounds heardi
a a a a a a a a a
n the left chest. A tension pneumothorax is reliev
ive
a a a a a a a a
ed by immediate needle decompression and tube
a a a a a a
thoracostomy. Subsequently, his heart rate decre
a a a a a a
hragmatic
ases to 140 beats per minute, his respiratory rate
a a a a a a a a a
decreases to 36 breaths per minute, and his bloo a a a a a a a a
utaneousae
d pressure is 80/50 inm Hg.Warmed Ringer's lact
a a a a a a a a
ate is administered intravenously. The next priori
a a a a a a
ty should be to:
a a a 11. 18-year-old,a helmeteda motor
performaaaurethrogramaandacystogram. a brought by ambulance to the em a a a a a
a perf tment following a high- a a a
ormaexternalafixationaofatheapelvis. speed crash. Prehospital persorm a a a
e was thrown15 meters (50 feet
a a a a a a