A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood after initial IV fluid resuscitation, a closed tube
... [Show More] thoracostomy is performed for decreased left breath sounds - ANSWER 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 - ANSWER complete spine x-ray series.
The principle of balanced resuscitation is: - ANSWER Permissive hypotension and early plasma infusion
Question:4 In managing the head-injured patient, the most important initial step is to - ANSWER secure 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? - ANSWER His systolic blood pressure will be decreased with a narrowed pulse pressure.
The diagnosis of shock must include - ANSWER poor organ perfusion
Question:9 A 7-year-old boy is brought to the emergency department by his parents several minutes after 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 - ANSWER direct pressure
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent - ANSWER cerebral vasoconstriction with diminished perfusion.
Question:11 A 25-year-old man is brought to a hospital with a general surgeon after being involved in a motor vehicle crash. Computed tomography 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 - ANSWER exploratory laparotomy.
20-year-old woman, at 32 weeks gestation, 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 - ANSWER perform needle 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? - ANSWER resp of 40/mi
Question:17 The most important, immediate step in the management of an open pneumothorax is - ANSWER placement of an occlusive dressing over the wound.
Question:18 The following are contraindications for tetanus toxoid administration - ANSWER History of neurological reaction or severe hypersensitivity to the product.
Question:19 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 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 pneumothorax as the cause of his hypotension? - ANSWER Breath sounds.
Question:20 Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because - ANSWER the trachea is relatively short.
Question:21 A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid solution are infused through 2 large-caliber IVs. 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). 1500cc of blood has drained from the right chest. The most appropriate next step in managing this patient is to - ANSWER urgently transfer the patient to the operating room.
Question:22 A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, 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 - ANSWER attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine.
Question:23 A patient is brought to the emergency department after 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? - ANSWER Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
Question:24 Which one of the following is the most effective method for initially treating frostbite? - ANSWER Moist heat.
Question:25 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, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessel and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? - ANSWER Perform right lower extremity fasciotomy.
Question:26 A patient arrives in the emergency department after 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 ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to - ANSWER suction the oropharynx.
Question:27 A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital at which surgical capabilities are not available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to - ANSWER perform an emergency department thoracotomy.
Question:29 Hemorrhage of 20% of the patient's blood volume is associated usually with - ANSWER tachycardia
Question:30 Which one of the following statements concerning intraosseous infusion is TRUE? - ANSWER Aspiration of bone marrow confirms appropriate positioning of the needle.
Question:31 A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to - ANSWER avoid hypotension.
Question:32 A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS Score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is - ANSWER cardiac tamponade.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to - ANSWER maintain inline immobilization and establish a definitive airway.
Question:37 Healthy young male in a motor vehicle crash is brought to the emergency department with a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: - ANSWER Placement of a pelvic binder
Question:39 A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is - ANSWER prepare for an exploratory thoracotomy.
Question:40 A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE? - ANSWER A pulmonary contusion may be present in the absence of rib fractures. [Show Less]