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1. The primary indication for transferring a
patient to a higher-level trauma center is:
unavailability of a surgeon or operating room
staff.
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multiple system injuries, including severe
head injury.
resource limitations as determined by the
transferring doctor.
resource limitations as determined by the
hospital administration.
widened mediastinum on chest x-ray
following blunt thoracic trauma.
2.teen-aged bicycle rider is hit by a truck
traveling at a high rate of speed. In the
emergency department, she is actively bleeding
from open fractures of her legs, and has
abrasions on her chest and abdominal wall. Her
blood pressure is 80/50 mm Hg, heart rate is
140 beats per minute, respiratory rate is 8
breaths per minute, and GCS score is 6.
The first step in managing this patient is to:
obtain a lateral cervical spine x-ray.
insert a central venous pressure line.
administer 2 liters of crystalloid solution.
perform endotracheal intubation and
ventilation.
apply the PASG and inflate the leg
compartments.
3.Contraindication to nasogastric intubation is
the presence of a:
gastric perforation.
diaphragmatic rupture.
open depressed skull fracture.
fracture of the cervical spine.
fracture of the cribriform plate.
4. Which one of the following statements
regarding patients with thoracic spine injuries is
TRUE?
Log-rolling may be destabilizing to
fractures from T-12 to L-1.
Adequate immobilization can be
accomplished with the scoop stretcher.
Spinal cord injury below T-10 usually spares
bowel and bladder function.
Hyperflexion fractures in the upper
thoracic spine are inherently unstable.
These patients rarely present with spinal
shock in association with cord injury.
5.young man sustains a ritle wound to the midabdomen. He is brought promptly to the
emergency department by prehospital
personnel. His skin is cool and diaphoretic, and
his systolic blood pressure is 58 rnm Hg.
Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next, most
appropriate step is to perform:
a celiotomy.
an abdominal CT scan.
diagnostic laparoscopy.
abdominal ultrasonography.
a diagnostic peritoneal lavage.
6.young woman sustains a severe head injury
as the result of a motor vehicular crash. In the
emergency department, her GCS score is 6. Her
blood pressure is 140/90 mm Hg and her heart
rate is 80 beats per minute. She is intubated and
is being 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:
administer an osmotic
diuretic.prevent secondary
brain injury.
aggressively treat systemic hypertension.
reduce metabolic requirements of the
brain.
distinguish between intracranial hematoma
and cerebral edema.
7.22-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 subdural hematoma.
an epidural hematoma.
a transected lumbar spinal cord.
a transected cervical spinal cord.
hemorrhage into the chest or abdomen.
8. 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:
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.
9. 8-year-old girl is an unrestrained passenger
in a vehicle struck from behind. In the
emergency department, her blood pressure is
80/60 mm Hg, heart rate is 80 beats per minute,
and respiratory rate is 16 breaths per minute.
Her GCS score is 14. She complains that her
legs feel "funny and won't move right;"
however, her spine x-rays do not show a
fracture or dislocation. A spinal cord injury in
this child:
is most likely a central cord syndrome.
must be diagnosed by magnetic resonance
imaging.
can be excluded by obtaining a CT of the
entire spine.
may exist in th [Show Less]