A 42-year-old man is trapped from the waist down beneath his overtumed tractor for several hours before medical
assistance arrives. He is awake and alert until just before arriving in the emergency department. He is now
...
A 42-year-old man is trapped from the waist down beneath his overtumed tractor for several hours before medical
assistance arrives. He is awake and alert until just before arriving in the emergency department. He is now
unconscious and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter and symmetrically
reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his lower
extremities. On examination in the emergency department, no movement of his lower extremities is detected, even
in response to painful stimuli. The most likely cause for this fmding is
A:
an epidural hematoma.
a pelvic fracture.
central cord syndrome.
intracerebral hemorrhage.
(E) bilateral compartment syndrome.
Q:
Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage
should be to
A:
treat the most severely injured patients first. establish a field triage area directed by a doctor. rapidly
transport all patients to the nearest appropriate hospital. treat the greatest number of patients in the shortest
period of time. produce the greatest number of survivors based on available resources
Q:
The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in
A:
placental abruption. fetal hypoxia and distress. fetal/maternal dysrhythmia. improved uterine
blood flow. increased maternal renal blood flow.
Q:
A 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of
the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats
per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the
left chest. A tension pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate
decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's
lactate is administered intravenously. The next priority should be to:
A:
perform a urethrogram and cystogram. perform external fixation of the pelvis.
obtain abdominal and pelvic CT scans. perform arterial embolization of the pelvic vessels.
perform diagnostic peritoneal lavage or abdominal ultrasound.
Q:
A 32-year-old man is brought to the hospital unconscious with severe facial injuries and noisy
respirations after an automobile collision. In the emergency department, he has no apparent
injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation
with a face mask is unsuccessful. Examination of his mouth reveals a large hematoma of the
pharynx with loss of normal anatomic landmarks. Initial management of his airway should
consist of
A:
inserting an oropharyngeal airvvay. inserting a nasopharyngeal airway. performing a
surgical cricothyroidotomy. performing fiberoptic-guided nasotracheal intubation.
performing orotracheal intubation after obtaining a lateral c-spine x-ray
Q:
Absence of breath sounds and dullness to percussion over the left hemithorax are fmdings best
explained by
A:
left hemothorax. cardiac contusion. left simple pneumothorax. left
diaphragmatic rupture. right tension pneumothorax.
Q:
An electrician is electrocuted by a downed power line after a thunderstorm. He apparently made
contact with the wire at the level of the right mid thigh. In the emergency department, his vital
signs are normal and no dysrhythmia is noted on ECG. On examination, there is an exit wound
on the bottom of the right foot. His urine is positive for blood by dip stick but no RBCs are seen
microscopically. Initial management should include
A:
immediate angiography. aggressive fluid infusion. intravenous pyleography.
debridement of necrotic muscle. admission to the intensive care unit for observation.
Q:
A 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole.
He is unconscious and in profound shock. He has no open wounds or obvious fractures. The
cause of his shock is MOST LIKELY caused by
A:
a subdural hematoma. an epidural hematoma. a transected lumbar spinal cord. a
transected cervical spinal cord. hemorrhage into the chest or abdomen.
Q:
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¬valve device. It becomes more
difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation
level decreases from 98% to89 % . The most appropriate next step is to
A:
obtain a chest x-ray. decrease the tidal volume. auscultate the patient's chest.
increase the rate of assisted ventilations. perform needle decompression of the left chest.
Q:
A 5-year-old boy is struck by an automobile and brought to the emergency department. He is
lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg
systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths per minute. The
preferred route of venous access in this patient is
A:
percutaneous femoral vein cannulation cutdown on the saphenous vein at the ankle.
intraosseous catheter placement in the proximal tibia. percutaneous peripheral veins in the
upper extremities. central venous access via the subclavian or interna1 jugular vein
Q:
A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He
is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per
minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His
GCS score is 6. Immobilization of the entire patient may include the use of all the following
EXCEPT
A:
air splints. bolstering devices. a long spine board. a scoop-style stretcher. a
semirigid cervical collar.
Q:
Which one of the following statements is FALSE concerning Rh isoimmunization in the pregnant
trauma patient?
A:
It occurs in blunt or penetrating abdominal trauma. Minor degrees of fetomaternal
hemorrhage produce it. A negative Kleihauer-Betke test excludes Rh isoimmunization.
This is not a problem in the traumatized Rh-positive pregnant patient. Initiation of Rh
immunoglobulin therapy does not require proof of fetomaternal hemorrhage.
Q:
A 42-year-old man is trapped from the waist down beneath his overtumed tractor for several
hours before medical assistance arrives. He is awake and alert until just before arriving in the
emergency department. He is now unconscious and responds only to painful stimuli by moaning.
His pupils are 3 mm in diameter and symmetrically reactive to light. Prehospital personnel
indicate that they have not seen the patient move either of his lower extremities. On examination
in the emergency department, no movement of his lower extremities is detected, even in response
to painful stimuli. The most likely cause for this fmding is
A:
an epidural hematoma. a pelvic fracture. central cord syndrome. intracerebral
hemorrhage. (E) bilateral compartment syndrome.
Q:
A crosstable, lateral x-ray of the cervical spine
A:
must precede endotracheal intubation. excludes serious cervical spine injury. is an
essential part of the primary survey. is not necessary for unconscious patients with
penetrating cervical injuries. is unacceptable unless 7 cervical vertebrae and the C-7 to T-1
relationship are visualized
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