3-1. A 23-year-old man is brought immediatety 10 the emergency department from the hospital's parking lot whete he was ches in the lower abdomen, Examinalkie reveals a single bullet wound. Hie is breathing and has a thready pulse. However, he is unconscious and has no deseciable blood pressure. Oiptimat bamediate management i 16 (A) petform diagnostic peritoneal lavage. (3) inate infusion of packed red Mood cells. (Ch) inser a nasogastric whe and urenary caibetct. (D1) transfer the patient to the operating room, while mitigating fuk! therapy - (E} initiave hued therapy co reum bis blood prestude bo normevensive levels. 32, A -yearold man sustains a severely comuminuted, open distal night femus fractare im a motorcycle crash. The wound i actively Meeding. Normal seniation is presen over he lateral aspect of the foot bul decreased over the medial Foot and greal te. Normal motionof the foot is obierved. Dorsalis pedis and posverior tehial pulics ate casily palpable on the fefl, bat heard ocly by Doppler on the right. Immediate efforts to mprowe emrculation to the pated exinemity shook’ involve 4A) immediate angiography: - (8) tamponade of the wound with a pressure dressing. (C) wound exploration and removal of bony fragments 4D) realignment of the fracture segments with a tractive splint (E) fasciosomy of all four camparimends in the lower extremity 33.0 Which obe of the following physical findings suggest a cause of hypotension other ther spinal cond injury? tA} priapism. (B) bradycariia. oC) diaphragmatic breathing, (D) presence of deep tendon reflenes, (E) —abality 09 fies forearms but inability vo extend them,34. A Meywar-old thee during a ‘MOSHAN PAMEDPST in an petomobile sartues the wind scrocm with bent earked facut Collinion. 1s the emergescy department, she a walking: sc hat ub a cy ay iE 4 and crepes, The biphest pricriny should be giemn to kateral, ¢-spine a-eay pret airway prospriam. carota” puter avsensenent manager of bho koma Sescrmibnaisan of associuned injuries. 35, An B-yeat-old girl bs as enrevrsined panwenger ina vebicle struck from bebml tm the emergency deparmment, her blocd: prestufe bb BOAO mem Hig. heme rte i 0 berais per minute, aad reaperatory rate bs 1G breath per mamute Her GCS core is 14. Sho complain thst Ber legs feel “funny and won't move right:” however, her apie x-rays So not show a fracture or daocution. A ypéeal cord injury im this child tA) “BD mo peznlt fa an injured, bypowolemic pregnant wom; can be (A) placental abcuption. (8) fetal byponia and distress, . (Ch) fetal masernal dysrhychrsta. 4{D) improved uterine blood flow. CE) increased marernal renal blond! flow. +15. An S-year-ohd boy falls 4.5 meters (15 feet) from a tree and is Ibrough: : the emergency depamment by his family. His vital sigos are normal, bet he complain: of left upper quastrant pain. An abdominal CT scan reveals a moderately severe laceratior of thee spleen. The receiving institution docs not barre 24-hous-a-day operating rooms capa=Littes. The most appropriate mumagement of this patient would be to ‘type and crossmaich for blood, request ecewultation of a pediatrician ‘transfer the patieni bo a trauma center. “ adneit the patient ta the intensive care writ. prepare the patient for surgery the next day. ggn8t +16. An electrician is clocrocuted by 2 downed power fine after a thundersinia. He made contact with the wire at ihe level of the right mid thigh. In the emergency deparment, his vital sigas are normal and mo dysrhyihmis bs soted on ECG On examination, there is an exit wound on the bostom of the right foot. His urine is positive for blood by diy stick bet no RIBCS are ween microscopically. Initial masagement should imchade 4A) lemnedine angiography. 4B) aggressive fluid infusion., 00) tniravenceis pyrleogranhy. (D) debridement of necrotic muscle. (2) achminsion 90 the intensive care unit for observation. ACH ATLA Te ABINA F ae Sereraged bicycle rider is hit by a track sraveling at a high rate of speed. In the ba ee eeTmeM. Abe is actively Bleeding from open fractures of her les, and has Siataace , and abdominal wall. Hee blood pressure is 80°80 men Hg, beart rate ALIPAC, respiralory rabe ii 8 breaths per rialmute. and GAS . first step in managing this paticm is wn ian “ore 4 The (A) obtain a lateral cervical spine xray. (8) insert 5 central venous pressure line. {C) administer 2 liners of crystalloid solution, 4D) perform endotracheal intubailon and ventilation- (E) apply the PASG and inflate the leg compartments. ene ane enemy one ieee ee earn oe ne GA) Log-roliling may be destabilizing to fractures from T-12 15 L-1. (B)) | Adequate immobilization can be accomplished with the scoop sireicher. fC) Spinal cord Injury below T-10 usually spares hawel and bladder fusction, (D) « Hyperflexion fractures in the upper thoracic sping are inberenily unstabte.” (E) «These patients rarely present with epinal shock in asiociation with cord injury. 3-19, A 24-year-old man suseains multiple fractured ribs bilsierally as a result of being crushed in.a press at a plywood factory, Examination in the emerpency department reveals a flad segment of the patient's thorax. Primary resuscitation inches high-flow omyeon administration via a nonrebreathing mask, and initiation of Ringer's lactate solution The patient exhibits progressive confusion, cyanosis, and tachypaca. Management at this time should consist of (A) iintravenoes sedation. (B) external stabilization of the chest wall. (C) increasing the FIO, im the inspired gas. (DB) invercostal nerve Mocks for pin relict. (E) endotracheal innubation and mechanical ventilation.3-20. A 17-year-old helmeted motorcyclia is. struck broadside by an aalomobide at an, intersection. He is unconscious ai the scene with a blond pressure of 140/90 mm Hp. heart Tate of 90 beats per minute, and respiratory rate of 22 breaths per minute, His nexperations are sonorous and deep. His GCS score is 6. Immobilization of the entire pater may ‘ipelude the use of all the following EXCEPT . (A) air splints. {B) bolstering devices, (Ch along spine board, (DD) a scoop-soyle strescher. (E) sw semirigid cervical collar. 321. A42-year-old man, injured ina motor vehicle crash. suffers a chited head injury, multiple palpable left rib fractures, and trilateral femur fractuecs. He is tnnahated ocotracheally without difficulty. Initially, bit ventilailons wre easily assivied with a bag- walve device. In bocomes noe difficult so ventilate the pauent over ihe neae 3 minutes, and his hemoglobin oxygen safdraibon level decreases froma 98% to-BO% . The-mest appropriate BEML step is to (A) obtabt a chest x-ray. (B) «decrease the tidal volume. €C) aumscultate the palicet's chest. (D) increase the rate of assisiod vondilations, perform needle decomprettion of the loft ches. 5 3-22. immediate chest be insertion Is Indicated for which of the following conditbons? Preursothoras, P ar Massive herothorse, Disphragmatic rupoare Subcurancont emphysema BooBE333. A 73-year-old woman js brought to the emergency department after a motor vehicle crash. She was initially lucid at the scene and then developed a ditated pupil and ‘contralateral cxiremily weakeeu. Inthe emergency departmnes, te iuncomsckous amd ha 3 .GCS score of 6, The nitiat masagernent wep for thes parient seule Be to tA) 1B) cy my (BE) Obtain a CT scan of the head adminivier decadron 20 mg TV. Perfotm eriicdracheal emnu/hation imitate an [V line and admanider Mannitol | p/hy perform an emergency burr hole on ithe side of the dilated grupil, 3-24, Early central venous pressure monitoring during Maid revescitatiog inthe emergency department has the gresicst wtiligy ina Ay (By cr cl) ey aliens with a splenic Raceracion. patient with an inbalation inpary. S-year-old chikd with a pelvic fracture, Paikent with a kevere cardiac: conbatiom, 24-year-old man with a mative hemothoras 3-25, Which of the following suscmens regarding injury to the central mervous system in children is TRUE? tA) a qcy (Dy ) ‘Children suffer spinal cond injury withoa! x-ray abeormaliy more commonly than sdesies, An infant with o thaamacic brain injury may become hypotensive from cerebral edema. Icinal therapy for the chikd with traumatic brain injury includes the administration of methylprednssotone intravenously, (Children have more focal mass iesbons as a rewaht of tragmanic brain infery when compared co adults ‘Young children are tess tolerant of expanding intracranial mass lesion: than adulin26. Twenty-seven pauiems are seri i (cme: riously injured in.an aircraft accident at a local airport. he basic principle Of triage should be io. , (A) Ureat the most severely injured patiems first. (B) establish a field wiage area directed by a doctor, (C) rapidly transport all patiems to the nearest appropriate hospital, (D) trea the greatest number of patients in the shortest period of time. 1E) produce the greatest number of survivors based on available resources. 27, A youtig man sustains a gunshox woond uo the abdomen and is brought prompely 19 ihe emergency depariment by orcbospital personne]. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive treatment in managing this patient is 6 (A) administer O-negative blood. (8) apply exrerral warming devices. (2) comirol internal hemorrhage operatively. (D) apply the paeumutic antishock garment. (2) infuse large volumes of invavenous crystalloid soutien, 3-28. A young woman sustains a severe head injury 2s the result of a movor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm He and her heart rate is ®0 bears per minute. She is intubaued and is being mechanically ventilated, Her pupils are $ mm in size and equally reactive to light. There is no orher apparent injury. The most important principle to follow in the early management of ber head injury is to = adininister an esmotic diuretic. mS ee (B) prevent secondary brain injury. eo aggressively treat systemic hypertension. AED) reduce metabolic requirements of the brain. OE) distinguish berween jncracranial hematoma and cerebral edema. 0E-91 60AS. Per serail a Sipe cat crash 1s orottacteully anfubaied i the hick! ty prehospital Personnel after they identify a closed head anpery and determine that the paticer is unabte fo protect hie alway. In ihe emergency department. the patient demonstrates decortacate Pestuting bilateralty . He ts being ventilated with a bag-valve device, but bis breath sounds ave absent in the left hemtithoran, Hin blood pressure is 160°KS om Hg. heat rate w 70 Beals pet timate, and (be pullse oximeter displays a hemogloban oxygen saturation of 6% ‘The nest sep in assessing and managing this palitnl shoukd be so An (By determine the anenad Mowd gases obtain w lateral cervical spine x-ray. asseat placement af the erxhtracteal cube Pertoren fecdle dkecostipredibon of the heft cheer immett a thoracostonay tube: in the bef hesmithoran. 35M. Contraindication to nasogastric intebetion is the pretence of a w By acy Dh (Ey asortc perforation. diaphoragimad: rupTUre open depresecd skull Fracrurd. fracnere of the cervical eplae. fracture of ube cribriform plate, Jl, A crossiable, bbteval a-tay of the cervical spine tab eB oO (D) iE} ius! precede endetractes! intubation. excludes scrinas cervical spine injury, is an exserilial part of the primary survey. fs not mocessary for unconscious patiene! with pencurading cervical iyparens is unaccepeable unkeas 7 cervical verweLrac and the C-7 oo 7-1 relaioehip ite vinuadined_ jy a Canfas tamponade after trauma oA) Bh ic a] (Ey a Oe is seickom life-threatening. ean he exchaded by an upright. AP chest x-ray. can be confused with a lenakon preumothoran. ’ causes a fall in systolic presaure of > |S men Hig wiih expiratin. meu commoniy oocun after blunt injury to the anterior chest «al!— cs a: ee 3-33. A 22-year-old men is brought to the hospital afer erashing his motorcycle into 4 telephowe pale. He is unconscious and in profound shock He has no open wounds or Sbvious fractures. The cause of his shock is MOST LIKELY catsed by (A) a subdural hematoma. : 4B) an epidural hematoma 4C) a transected lumbar spinal cord. (D) a kransected cervical spinal cord, TE) hemorthage int the ches of abdomen. 3-4. A young man susains a rifle wound to the mid-abdomen. He it brought Prompély to the emergency department by prebospital personnel. Mis skim is cool and diaphoretic, and his systolic biood preacure is 58 mm Hg. Warmed crystalloid fhuids are initiated without improvernent in bis vital signs, The neal, most appropriate step ix bo perform (Ay acelictomy. (6) an abdominal CT scan CC) diagnostic laparcicopy. {D} abdominal ultrasonography. (EB) a diagnostic perisonea! lavage 4438, All of the following signs on the chest a-ray of a blunt injury victim may suggest aortic rupture EXCEPT: (A) mediastinal emphysema. (B) presence of a “pleural cap.” (D) deviation of the trachea to the right. (E) depression of the beft mainstem beonchus. QE-9L G0-G93-2¢eee | pected Uishanadoetars ls brought to the Ihospital unconsclous with severe facial injuries ae TeSpirations after an swiomobile collision. la the emergency department, be has PPAFEM injury to the amerion aspect of his neck, He saddenly becomes apneic, and atempied ventilation with 4 face mask is unsuccessful, Examination of his mouth reveal a urge hematoma of the pharynx with Joss of normal anatomic landmarks. Initial management of his airway should consis of (A) iserting an oropharyngeal airway. (8) inserting a nasopharyngeal airway (Cy performing a surgical cesoochyroidotomny, (D) performing fiberopisc-guided masotracheal intubation. 4E) performing orotracheal intubation after obtaining a lateral c-spine x-ray. 3-37. A Seyear-old boy is stack by an auwmobile and brought to the emengency department. He is lethargic, but withdraws purposefially from painful stimuli. His blood pressure is. 90 mm Mg systotic, heart rate is 140 beats pew minute, and his respiratory role is 36 breaths per minute, The preferred route of venous access in that patkent bs (A) percutancous femoral vein cannulation. (8) cutdown on the saphenous vein at the ankle. OC) imtranssoous cathzer placement in the prostimal bia. (D) — percurancous peripheral veins in the upper extremities, rio] central venous access via the sabelavian ov internal jugular ween. 3.36, Absence of breath sounds and dullness to percussion ower the left hemithorax are findings bew explained by (Ab Jett hemothorax. (B) cardiac contusion. (Cy deft simple pneumothorax. (D) bef diaphragmatic rupsure, CE) right tension pneumothorax.3-39. An 18-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash, Prehospital personne! report that be was thrown 13 meters (50 feet) off his bike. He has a history of hypotension prior to arrival in the emergency depariment, but is now awake, alent, and conversational. Which off the following aiatement i TRUE? (Ab Cerebral perfusion 1s intact. 1B) Wtittavascular volume status is noel. OC) The paticot has sensitive vasemenor refleses, 4D) Untraatdormanal visceral injuries are unlikely (Ei The patient probably has an acuve epidural hematoma, 3-40. To establish a diagnosis of shock, (A) systolic oad pressure must be below 90 mm He. (B) the presence of a closed head injury should be exeluded. (Ch ackdosis should be present by arterial bbood gas analysis. (Dp the pation: must fail to respond fo intravenous fluid infusion. (EB) clinical evidence of inadequate organ perfusion must be present.