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1. A 22-year-old man is hypotensive and tachycardic af- re-examine the chest
ter a shotgun wound to the left shoulder. His blood
pressure is initially 80/40 mm Hg. After initial fluid
resuscitation 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 appropriate next step is:
2. A construction worker falls two stories from a building complete spine x-ray se-
and sustains bilateral calcaneal fractures. In the emer- ries
gency 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:
3. Which of the following is true regarding the initial Evidence of improved per-
resuscitation of a trauma patient? fusion after fluid resusci-
tation could include im-
provement in Glasgow
Coma Scale score on
reevaluation.
4. In managing a patient with a severe traumatic brain secure the airway
injury, the most important initial step is to:
5.
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A previously healthy, 70-kg (154-pound) man suffers An ABG would demon-
an estimated acute blood loss of 2 liters. Which one of strate a base deficit be-
the following statements applies to this patient? tween -6 and -10 mEq/L.
6. The physiological hypervolemia of pregnancy has clin- increasing the volume of
ical significance in the management of the severely blood loss to produce ma-
injured, gravid woman by: ternal hypotension
7. The best assessment of fluid resuscitation of the adult urinary output of 0.5
burn patient is: mL/kg/hr
8. The diagnosis of shock must include: evidence of inadequate
organ perfusion
9. A 7-year-old boy is brought to the emergency de- direct pressure on the
partment by his parents several minutes after he fell wound
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:
10. For the patient with severe traumatic brain injury, pro- cerebral vasoconstriction
found hypocarbia should be avoided to prevent: with diminished perfusion
11. After being involved in a motor vehicle crash, a perform an exploratory la-
25-year-old man is brought to a hospital that has parotomy
surgery capabilities available.. Computed tomogra-
phy of the chest and abdomen shows an aortic injury
and splenic laceration with free abdominal fluid. His
blood pressure falls to 70 mm Hg after CT. The next
step is:
12.
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Which one of the following statements regarding ab- Leakage of amniotic fluid
dominal trauma in the pregnant patient is TRUE? is an indication for hospi-
tal admission.
13. The first maneuver to improve oxygenation after administer supplemental
chest injury is: oxygen
14. A 25-year-old man, injured in a motor vehicular crash, 9
is admitted to the emergency department. His pupils
react sluggishly and his eyes open to pressure. He
does not follow commands, but he does moan pe-
riodically. His right arm is deformed and does not
respond to pressure; however, his left hand reaches
purposefully toward the stimulus. Both legs are stiffly
extended. His GCS score is:
15. A 20-year-old woman who is at 32 weeks gestation, is perform needle or fin-
stabbed in the upper right chest. In the emergency ger decompression of the
department, her blood pressure is 80/60 mm Hg. She right chest
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:
16. Which one of the following findings in an adult is most respiratory rate of 40
likely to require immediate management during the breaths per minute
primary survey?
17. The most important, immediate step in the manage- placement of an occlusive
ment of an open pneumothorax is: dressing over the wound
18.
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CORRECT DETAILED ANSWERS WITH RATIONALES (100% VERIFIED AN-
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The following are contraindications for tetanus toxoid history of neurological re-
administration: action or severe hypersen-
sitivity to the product
19. A 56-year-old man is thrown violently against the breath sounds
steering wheel of his truck during a motor vehicle
crash. On arrival in the emergency department he is
diaphoretic 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
differentiates cardiac tamponade from tension pneu-
mothorax as the cause of his hypotension?
20. Bronchial intubation of the right or left mainstem The trachea is relatively
bronchus can easily occur during infant endotracheal short.
intubation because:
21. A 23-year-old man sustains 4 stab wounds to the up- urgently transfer the pa-
per right chest during an altercation and is brought tient to the operating
by ambulance to a hospital that has full surgical ca- room
pabilities. His wounds are all above the nipple. He is
endotracheally intubated, closed tube thoracostomy
is performed, fluid resuscitation is initiated through 2
large-caliber IVs. FAST exam does not reveal intraab-
dominal 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 (ventilated with 100%
O2). 1500 mL of blood has drained from the right
chest. The most appropriate next step in managing
this patient is to: