VERIFIED QUESTIONS AND DETAILED
SOLUTIONS
◉ 2. The patient's respiration improves markedly, but he remains
confused. He has an absent radial pulse, and his carotid pulse is fast
and thready. Your partner asks if he can let the compression go to
put in an IV. How should you respond?
A. "Oh yes, that's a great idea!"
B. "Yes, but we have to immobilize him first"
C. "Take a blood pressure first to see if he needs an IV."
D. "No, keep the pressure and let's get out of here!". Answer:
Question 2: D
This patient is likely in decompensated shock with internal bleeding,
so rapid transport is the next priority. You should maintain pressure
on the wound, because having massive external bleeding start up
again is the last thing you want in this situation.
◉ 3. While en route to the hospital, you manage to put an 18-gauge
IV in the right arm. Your patient is still confused, and you still have
no radial pulse. Your next move is to:
A. give 1-L fluid bolus.
B. give one 250-mL fluid bolus, and then stop.
, C. give fluid until you get a radial pulse.
D. administer TXA.. Answer: Question 3: C
Now is the time to titrate IV fluids to restore tissue perfusion. Giving
1 liter blindly could overshoot your target pressure and reinforce
internal bleeding. TXA is not a priority, although it can run parallel to
fluids.
◉ 4. After 400 mL of lactated Ringer solution, you get a radial pulse
and his level of consciousness improves. The monitor shows heart
rate 110 beats/minute, blood pressure 85/60mm Hg, SpO2 95%,
ventilation rate 25 breaths/minute. What should you do?
A. Give an additional 500 mL of lactated Ringer solution.
B. Stop fluids and give 2 g of TXA.
C. Give TXA and 500 mL of normal saline.
D. Give 2 mg of morphine for analgesia.. Answer: Question 4: B
The patient does not need more fluids right now. Giving morphine in
a shocked patient is a risky move and could lead to dangerous
hypotension.
◉ 5. You now perform a secondary survey. You notice a sternotomy
scar. Your patient tells you he is on oral clopidogrel since he had a
coronary artery bypass graft 2 years ago. Is this information useful?
A. No, he should stop talking and breathe.
B. Yes, he should see a cardiologist once in the local hospital.