A 22-year-old man is hypotensive and tachycardic after 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.
...
A 22-year-old man is hypotensive and tachycardic after 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:
Select one:
a.
reexamine the chest
b.
perform an aortogram
c.
obtain a CT scan of the chest
d.
obtain arterial blood gas analyses
e.
perform transesophageal echocardiography
A) Reexamine the chest
A construction 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:
Select one:
a.
angiography
b.
compartment pressures
c.
retrograde urethrogram
d.
Doppler ultrasound studies
e.
complete spine x-ray series
e) Complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient?
Select one:
a.Page 2 of 18
A patient that presents with a torso gunshot wound and is hypotensive should receive crystalloid
fluid resuscitation until the blood pressure is normal
b.
Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow
coma scale score on reevaluation
c.
Massive transfusion is defined as transfusion of more than >10 of packed red blood cells and
plasma in 24 hours
d.
When tranexamic acid is administered by pre-hospital providers a second dose is required within
24 hours
e.
Fluid resuscitation is far more important than bleeding control in trauma patients
b.
Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow
coma scale score on reevaluation
In managing a patient with a severe traumatic brain injury, the most important initial step is to:
Select one:
a.
Secure the airway
b.
obtain a c-spine film
c.
support the circulation
d.
control scalp hemorrhage
e.
determine the GCS score
Feedback
Your answer is corr
a.
Secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters.
Which one of the following statements applies to this patient?
Select one:
a.
His pulse pressure will be widened.
b.Page 3 of 18
His urinary output will be at the lower limits of normal.
c.
He will have tachycardia, but no change in his systolic blood pressure.
d.
An ABG would demonstrate a base deficit between -6 and -10 mEq/L
e.
His systolic blood pressure will be maintained with an elevated diastolic pressure.
d.
An ABG would demonstrate a base deficit between -6 and -10 mEq/L
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