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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 2 liters of crystalloid
solution 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. His breath
sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation,
a closed tube thoracostomy is performed for decreased left 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:
a)
reexamine the chest.
b)
perform an aortogram.
c)
obtain a CT scan of the chest.
d)
obtain arterial blood gas analyses - ANSWER: a) reexamine the chest
Which one of the following physical findings suggests a cause of hypotension
other than spinal cord injury?
a)
priapism.
b)
bradycardia.
c)
diaphragmatic breathing.
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d)
presence of deep tendon reflexes. - ANSWER: d) presence of deep tendon
reflexes.2 | P a g e
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:
a)
compartment pressures
b)
retrograde urethrogram
c)
Doppler-ultrasound studies
d)
complete spine x-ray series - ANSWER: d) complete spine x-ray series
In managing the head-injured patient, the most important initial step is to:
a)
obtain c-spine film.
b)
secure the airway.
c)
support the circulation.
d)
control scalp hemorrhage. - ANSWER: b) secure the 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?
a)
His pulse pressure will be widened.
b)
His urinary output will be at the lower limits of normal.
c)
He will have tachycardia, but no change in his systolic blood pressure.
d)
His systolic blood pressure will be decreased with a narrowed pulse
pressure. - ANSWER: d) His systolic blood pressure will be decreased with a
narrowed pulse pressure.3 | P a g e
The physiologic hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by:
a)