1. The primary indication for transferring a 4. Which one of the following s
patient to a higher level trauma center is: regarding patients with thoracic
TRUE?
unavailability of a surgeon or operating room Log-rolling may be destab
staff. fractures from T
multiple system injuries, including severe Adequate immobilizati
head injury. accomplished with the scoop
resource limitations as determined by the Spinal cord injury below T-10 usua
transferring doctor. bowel and bladder
resource limitations as determined by the Hyperflexion fractures in t
hospital administration. thoracic spine are inherently
widened mediastinum on chest x-ray These patients rarely present w
following blunt thoracic trauma. shock in association with co
2. teen-aged bicycle rider is hit by
b y a truck 5. young man sustains a ritle w
traveling at a high rate of speed. In the abdomen. He is brought promp
emergency department, she is actively bleeding emergency department by preho
from open fractures of her legs, and has personnel. His skin is cool and
abrasions on her chest and abdominal wall. Her his systolic blood pressure is 58
blood pressure is 80/50 mm Hg, heart rate is Warmed crystalloid fluids are in
140 beats per minute, respiratory rate is 8 improvement in his vital signs.
breaths per minute, and GCS score is 6. appropriate step is to perform:
The first step in managing this patient is to: ac
an abdomina
obtain a lateral cervical spine x-ray. diagnostic lap
insert a central venous pressure line. abdominal ultraso
administer 2 liters of crystalloid solution. a diagnostic peritone
perform endotracheal intubation and
ventilation.
apply the PASG and inflate the leg
6. young woman sustains a seve
compartments. as the result of a motor vehicula
emergency department, her GC
blood pressure is 140/90 mm H
3. Contraindication to nasogastric intubation is rate is 80 beats per minute. She
the presence of a: is being mechanically ventilated
gastric perforation. 3 mm in size and equally
equall y reacti
diaphragmatic rupture. There is no other apparent injur
open depressed skull fracture. important principle to follow in
fracture of the cervical spine. management of her head injury
, aggressively treat systemic hypertension. 9. 8-year-old girl is an unrestrai
reduce metabolic requirements of the in a vehicle struck from behind
brain. emergency department, her blo
distinguish between intracranial hematoma 80/60 mm Hg, heart rate is 80 b
and cerebral edema. and respiratory rate is 16 breath
Her GCS score is 14. She comp
legs feel "funny and won't mov
7. 22-year-old man is brought to the hospital
however, her spine x-rays do no
after crashing his motorcycle into a telephone
fracture or dislocation. A spinal
pole. He is unconscious and in profound shock.
this child:
He has no open wounds or obvious fractures.
is most likely a central cord s
The cause of his shock is MOST LIKELY
must be diagnosed by magnetic r
caused by:
a subdural hematoma.
can be excluded by obtaining a
an epidural hematoma.
en
a transected lumbar spinal cord.
may exist in the absence of
a transected cervical spinal cord.
findings on x-ra
hemorrhage into the chest or abdomen.
is unlikely because of the in
calcification of the vertebr
8. 30-year-old man is struck by a car traveling
at 56 kph (35 mph). He has obvious fractures of 10. Immediate chest tube insert
the left tibia near the knee, pain in the pelvic for which of the following cond
area, and severe dyspnea. His heart rate is 180 Pneu
beats per minute, and his respiratory rate is 48 Pneumome
breaths per minute with no breath sounds heard Massive he
in the left chest. A tension pneumothorax is Diaphragmat
relieved by immediate needle decompression Subcutaneous em
and tube thoracostomy. Subsequently, his heart
rate decreases to 140 beats per minute, his
respiratory rate decreases to 36 breaths per 11. 18-year-old, helmeted moto
minute, and his blood pressure is 80/50 inm Hg. brought by ambulance to the em
Warmed Ringer's lactate is administered department following a high-sp
intravenously. The next priority should be to: Prehospital persormel report tha
perform a urethrogram and cystogram. 15 meters (50 feet) off his bfice
perform external fixation of the pelvis. history of hypotension prior to
obtain abdominal and pelvic CT scans. emergency department, but is n
perform arterial embolization of the pelvic and conversational. Which of th
vessels. statements is TRUE?
perform diagnostic peritoneal lavage or Cerebral perfiision
, Intraabdominal visceral injuries are defmitive treatment in managin
unlikely. to:
The patient probably has an acute administer 0-negat
epidural hematoma. apply extemal warmin
control internal hemorrhage op
apply the pneumatic antishock
12. crosstable, lateral x-ray of the cervical
infuse large volumes of int
spine:
crystalloid
must precede endotracheal intubation.
excludes serious cervical spine injury.
is an essential part of the primary survey. 16. To establish a diagnosis of s
is not necessary for unconscious patients systolic blood pressure must be
with penetrating cervical injuries.
is unacceptable unless 7 cervical vertebrae the presence of a closed head inju
and the C-7 to T-1 relationship are be
visualized. acidosis should be present by arte
\ga
the patient must fail to re
13. During resuscitation, which one of the
intravenous fluid
following is the most reliable as a guide to
clinical evidence of inadequ
volume replacement?
perfusion must b
Pulse rate
Hematocrit
Blood pressure 17. Absence of breath sounds a
Urinary output percussion over the left hemitho
Jugular venous pressure best explained by:
left hem
cardiac c
14. Which one of the following is the left simple pneum
recommended method for initially treating
left diaphragmati
frostbite?
right tension pneum
Vasodilators
Anticoagulants
Warm (40°C) water 18. 17-year-old helmeted motor
Padding and elevation broadside by an automobile at a
Topical application of silvasulphadiazine He is unconscious at the scene w
pressure of 140/90 mm Hg, hea
beats per minute, and respirator
15. young man sustains a gunshot wound to the breaths per minute. His respirat
abdomen and is brought promptly to the sonorous and deep. His GCS sc
patient to a higher level trauma center is: regarding patients with thoracic
TRUE?
unavailability of a surgeon or operating room Log-rolling may be destab
staff. fractures from T
multiple system injuries, including severe Adequate immobilizati
head injury. accomplished with the scoop
resource limitations as determined by the Spinal cord injury below T-10 usua
transferring doctor. bowel and bladder
resource limitations as determined by the Hyperflexion fractures in t
hospital administration. thoracic spine are inherently
widened mediastinum on chest x-ray These patients rarely present w
following blunt thoracic trauma. shock in association with co
2. teen-aged bicycle rider is hit by
b y a truck 5. young man sustains a ritle w
traveling at a high rate of speed. In the abdomen. He is brought promp
emergency department, she is actively bleeding emergency department by preho
from open fractures of her legs, and has personnel. His skin is cool and
abrasions on her chest and abdominal wall. Her his systolic blood pressure is 58
blood pressure is 80/50 mm Hg, heart rate is Warmed crystalloid fluids are in
140 beats per minute, respiratory rate is 8 improvement in his vital signs.
breaths per minute, and GCS score is 6. appropriate step is to perform:
The first step in managing this patient is to: ac
an abdomina
obtain a lateral cervical spine x-ray. diagnostic lap
insert a central venous pressure line. abdominal ultraso
administer 2 liters of crystalloid solution. a diagnostic peritone
perform endotracheal intubation and
ventilation.
apply the PASG and inflate the leg
6. young woman sustains a seve
compartments. as the result of a motor vehicula
emergency department, her GC
blood pressure is 140/90 mm H
3. Contraindication to nasogastric intubation is rate is 80 beats per minute. She
the presence of a: is being mechanically ventilated
gastric perforation. 3 mm in size and equally
equall y reacti
diaphragmatic rupture. There is no other apparent injur
open depressed skull fracture. important principle to follow in
fracture of the cervical spine. management of her head injury
, aggressively treat systemic hypertension. 9. 8-year-old girl is an unrestrai
reduce metabolic requirements of the in a vehicle struck from behind
brain. emergency department, her blo
distinguish between intracranial hematoma 80/60 mm Hg, heart rate is 80 b
and cerebral edema. and respiratory rate is 16 breath
Her GCS score is 14. She comp
legs feel "funny and won't mov
7. 22-year-old man is brought to the hospital
however, her spine x-rays do no
after crashing his motorcycle into a telephone
fracture or dislocation. A spinal
pole. He is unconscious and in profound shock.
this child:
He has no open wounds or obvious fractures.
is most likely a central cord s
The cause of his shock is MOST LIKELY
must be diagnosed by magnetic r
caused by:
a subdural hematoma.
can be excluded by obtaining a
an epidural hematoma.
en
a transected lumbar spinal cord.
may exist in the absence of
a transected cervical spinal cord.
findings on x-ra
hemorrhage into the chest or abdomen.
is unlikely because of the in
calcification of the vertebr
8. 30-year-old man is struck by a car traveling
at 56 kph (35 mph). He has obvious fractures of 10. Immediate chest tube insert
the left tibia near the knee, pain in the pelvic for which of the following cond
area, and severe dyspnea. His heart rate is 180 Pneu
beats per minute, and his respiratory rate is 48 Pneumome
breaths per minute with no breath sounds heard Massive he
in the left chest. A tension pneumothorax is Diaphragmat
relieved by immediate needle decompression Subcutaneous em
and tube thoracostomy. Subsequently, his heart
rate decreases to 140 beats per minute, his
respiratory rate decreases to 36 breaths per 11. 18-year-old, helmeted moto
minute, and his blood pressure is 80/50 inm Hg. brought by ambulance to the em
Warmed Ringer's lactate is administered department following a high-sp
intravenously. The next priority should be to: Prehospital persormel report tha
perform a urethrogram and cystogram. 15 meters (50 feet) off his bfice
perform external fixation of the pelvis. history of hypotension prior to
obtain abdominal and pelvic CT scans. emergency department, but is n
perform arterial embolization of the pelvic and conversational. Which of th
vessels. statements is TRUE?
perform diagnostic peritoneal lavage or Cerebral perfiision
, Intraabdominal visceral injuries are defmitive treatment in managin
unlikely. to:
The patient probably has an acute administer 0-negat
epidural hematoma. apply extemal warmin
control internal hemorrhage op
apply the pneumatic antishock
12. crosstable, lateral x-ray of the cervical
infuse large volumes of int
spine:
crystalloid
must precede endotracheal intubation.
excludes serious cervical spine injury.
is an essential part of the primary survey. 16. To establish a diagnosis of s
is not necessary for unconscious patients systolic blood pressure must be
with penetrating cervical injuries.
is unacceptable unless 7 cervical vertebrae the presence of a closed head inju
and the C-7 to T-1 relationship are be
visualized. acidosis should be present by arte
\ga
the patient must fail to re
13. During resuscitation, which one of the
intravenous fluid
following is the most reliable as a guide to
clinical evidence of inadequ
volume replacement?
perfusion must b
Pulse rate
Hematocrit
Blood pressure 17. Absence of breath sounds a
Urinary output percussion over the left hemitho
Jugular venous pressure best explained by:
left hem
cardiac c
14. Which one of the following is the left simple pneum
recommended method for initially treating
left diaphragmati
frostbite?
right tension pneum
Vasodilators
Anticoagulants
Warm (40°C) water 18. 17-year-old helmeted motor
Padding and elevation broadside by an automobile at a
Topical application of silvasulphadiazine He is unconscious at the scene w
pressure of 140/90 mm Hg, hea
beats per minute, and respirator
15. young man sustains a gunshot wound to the breaths per minute. His respirat
abdomen and is brought promptly to the sonorous and deep. His GCS sc
