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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: -
ANSWER--re-examine 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
Which of the following is true regarding the initial resuscitation of
a trauma patient? - ANSWER--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: - ANSWER--secure the airway
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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--An ABG would demonstrate
a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical
significance in the management of the severely injured, gravid
woman by: - ANSWER--increasing the volume of blood loss to
produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn
patient is: - ANSWER--urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: - ANSWER--evidence of
inadequate organ perfusion
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 on the wound
For the patient with severe traumatic brain injury, profound
hypocarbia should be avoided to prevent: - ANSWER--cerebral
vasoconstriction with diminished perfusion