ouns a |.42-yarold man nbrought to the amergency department 25 minutes afr being Invied in ahgh-tpetd ator rox ‘hil olson n which he was a restrained passenger. On ark he as shores of breath nd in severe pan Ms Dulseis120/mirecpatons ae 25min ana bid pressure 3040 mn sg Cxaminaon snows supertllabratons rd lu creas a the ef shuler eval Cada exarination hoe achycarda with ne maar iby, o lps The Sreth sound ar set on te fH inte ara achaicalyvetlted. Two large bre inraverous cates re placa and isin of 0 sl bag ch [tose folowing he most Hay cae of hi aymptor? Sie ‘Ths patent shows th invad movement of he chest nal during nspationpuradoncal movement Wa i chaacnsc offialchert. this canton uel resus fom high-impact bun aun ote chst eg, motor veh oson- atone ‘wth a enest comment exit dyspnea and tchyonea as Sgn of respator Fare due 0 unaernglung contusion, sis seenin spate, fa shea ree | Ja gt ouns ul 1.¢2-yar oldman brought tthe emergency department 25 minutes sft being nvhed a ahigh-rpeed ator rox ‘hil olson n which he was a restrained passenger. On ark he as shores of breath nd in severe pan Ms Dulseis120/mirecpatons ae 25min ana bid pressure 3040 mn sg Cxaminaon snows supertllabratons rdf creas a the ef suler level Cardia exarination hos tachycardia with ne mma yo lop The Sreth sound ar set on te fH inte ara achaicalyvetlted. Two large bre inraverous cates re placa and isin of 0 sl bag ch [tose folowing he most Hay cae of hi aymptor? ‘Mechanical vettaton wth postive nd-expiatry pressure hls Coun the pradonclbrethng described here, 2a ‘ Diaphragmatic rp i elathely cmon afer motor while colons and often asynpomat. Tis patent has absent ‘pean Sounds oe et nrthorax but lacs the aacerste psi examination Has bowel sounds ove the ‘peta of lphrapmate rupture In aon, aphespmatic rupture woud not expan the paradocs verano he chest wall on spain seen mths patert rani nave damage may be caved by au malgnancy, or urgry and esl in pail er compat paras ofthe aphasia nerve barat maybe asrptomatic or manifest wth dysanes Unter prec nerve paar leads {he parade upward movement ofthe ated hedaphragm, Te cndion would ot, Rowever, expla the patasonca Carta tamponaae typically rere th mypotnsen,tchyara, jugular venus tention, ane pul paradox !Aliough his pate hypotensive and tachycac, no other Signs of crac tamponade are present. neon, cardac ‘amponade weld na expan ie parade moun cf the chest walOnne a <1 vis > raprvaamatc rapture rete common ater motor venice Couns ands otenasytoManc Ins pave nas eat sounds onthe et hemithorax ut ks we chatacesc physical aration ings owe sounds ev te Ineithoan) of hphragmatc upturn adstion, daphapratcreptre woud nol expla the peradowcal moverent ofthe chest wall on spain seen mths pate ‘Prem are damage may be aus by sauna, malgnary, or surgery and result m paral r comple paralysis ofthe ‘taphrar rene nerve paras maybe asmpfomatc or manifest wth dysones, Ustralpreic nerve peas ads 1 ‘he paraoscal upmard movers oe afectedhericaphragm, The conion would not, Rowever, expla the paradocs Catia tamponade typically rernt ah nypotnsen,tachyara,juglar venous dutention, and pul paradox ‘Aiouh his pate s hypotensive and achycae no other sigs of eve tamponade are present neon cardlac ‘amponade would na expan ie parade motion ofthe chest wal. Sterna tactre classically occurs after Dlr antes chest aura such 5 tat caused by 2 motor vehicle olson. son ssodued with catia! cantons. though ths pave may Nave af assed Steal aur, CE ype ry oes tet suture onan he respetory dns athe pada mavnent of chet wall ‘Ths patent shows the insard movement of th lf chest wall dung mspration paradoxical movement) tha characte fla chest This conton ual resus from high-impact lum va tote chest eg, meta vec olson) Paes a at Co er at pre pre pp tase te risips etconee ae| 74.yarold man undergue an gen choleetctry Surgery i pefoomed under gnarl anche for hich the Dates bated with an endovaches tube vet fllowing th procedure, Ms temperatures 37° OGG7) ple i tyme ar bow pressures 110/60 min Hs He i eubated as Soon as he Showed signs ares. Fhe mites ed ec pel eee era teed per dre stenna of he nae coronary artery 10 yrs go. He smoked one pack of ares dal for 40 yeas ut gu 2 weeks ‘go for surgery He inks one ooo bees daly Hs cient meskaton nude maton, ela espn, Provera e130) 801mm hig Puc oxy shows a oxygen stun of 73% He put on 2 Rot tebeathor mask wth nF; oF 1008 Three mutes acer, ne sil unresponsive Hs terl ood Ges aa shows Foo: amma Heo) 2a meqit hich af he flowing ithe bart nent step inthe management of he pen? be (© close observation ony (Oban an ecrocariograma we ouns al <2 tim > | 74.yarold man undergue an gen choleetctry Surgery i pefoomed under gnarl anche for hich the x patersimubated with an endoachel tube Diet flloaing the procedure, Ms temperature 37 GACT) pulses oymie ara boca pressures 110/60 min Hs, He cubated as Son as He Showed sighs faeries. Fe mates tate He has type 2 betes melo, cronay artery dese, and hypertension Me undewent stenia of me nae coronary artery 10 yrs go. He smoked one pack of ares dal for 40 years ut gu 2 weeks “go for surgery He inks one ooo bes daly His cient meskaton nude maton, ela espn, ‘Sovesain and « multi i temperatre i 3% 96.99, pus 102m repraton re 20/mrn and aod prosere 130/80 mm hg. Pule one shows a oxygen ERE. Me | a nF; oF 1008 Three mutes acer, ne sil unresponsive Ms aterl blood Ges ana sows foo: Ja mm a Heo) Gamat Op saturation 734 hich af he flowing ithe bart nent step inthe management of he pen? “Ths pala nas hyponemia dung the postoperative patiod dese ecehing 100K oxygen and as BES Sco <3 J sceate eis unesponsie. Wat shoul be done next? 2a Z ‘Ths uresporsive patent th hypoxemia reqs iasve velar, but nen-surgial aay verlagenstou be et tr ee ee rs te ce et eae 9 ‘spate as alow 205 of 73 meg ep recaving 1008 angen va a non-rebventer mask, anda a0, woud nt be ‘expected to improve by contmumg ms rest SINC eI YPoREMIC ane ViresponsNe, a erent procedures equwed fo ‘oi shneaiunet li icoleeta sederiee iOe lo mumorvs Sa anion poked pee by contin i Leame Sees poten and Uaeiorsn,aiTeet procedure requres 1 pave who i unresponsive the tongue may all bak nd te pharyngeal ay cle, causing away hereon. chan hs metabolic aro cadovaclar ik factor, and een person, the patently had = myocar Infree nthe postoperative pend. The pavent may so nav a verlation perfusion mismatch a5 2 result of alerts ‘nde pulmonary dena fowng te Moh of hes conans recat n Mone tat ds rox improve wth a Or Atay management sod venation Cberation witout wtersenon Is napproprite because i patent weesprav, unable a pote: areas nl Joa F203 of 73mm Hp dese receving 100% oxygen via nn-inasve venlator A procedure to Secure Ms aways recess. | Ps amethod of ner mvasi vermtion,Non-vasie vntlaon snot appropri nhs unresponsive pater because ‘ne eay ot be alto atta pate aways. Hs Lge may al ac, and Ue payngcal musces may ealapse leading To (Ghani mataboke aeons, avascular ik fastors, and erat oparanon ths pans hypocamia oul be Yo 2 ‘entation erosion mismatch rom pulmonary edema folowing a yeriperae myocardial inaction. An EXC woul helo lugrose 2 suspected myoca/al arco, bute HS Ses Sang Bs pales ecu Ms araays AG shoul bewos s <2 tim > Dee et cereale es eee tay erent eect ered ‘mount ofyonsh sputun. He has hada 6-k (13-1 eight los ring ths pod, He emigrated om the wide Est ‘oun 2 yes ago father eed ong cancer athe geo 4 as Me has smoked one pak of Courtesy for years. Me appears malnourohed. his temperatures 261°C (100.67 pubes 10min an bond presen 118772 mm cracls are Rear on austin of te chest. Caralacexaminaton shows no zbrormalles. The lbomen Sf ana nontender. Laboratory Stes show amoalbin 123910 feytroee sedmertaton rte_66:mmh reine oemgat ‘una wth normal lente. Anaya the hate sh whieh afte following the Moe sppropate NOX ep (O[ tite aterc ant omen ate (©) Fein a high-resolution CT scan ofthe cast be (©) ote spun specimens fr £8 seat microscooy cule, nd nce so arian 15) reer ieaaciveiciaal Seg hae Wt a aewos Hemealoin nage atelet coune 330,000/rma? ytvoge sedmeeaton ate G6:mm W Shcose Tmoid. Gretnine os mgiat “unas swith nor nits Any of the hess shan ich oe follwing ee Moe Appromne next eo lomanagemen (©) fo care doen ets ectorm a high-resolution CT scan ote chest (© stare wesinent wn or estowsen (©) Cate spam specimens fr AFG seat meronopy clue, nd ace ai arpieation (© Fectonn ransbronchial lang bape of the susp son (© Petorm an certeton-ganma release assayPost-primary tuberculosis a) crescxcry a vew) eas Seren bride eireeraig Peer serene emer etentroen eee Eacemerreeyeeen) Saree ee ier peered oe ee) pee Saeed cae pair reie aea eT enntinyPost-primary tuberculosis a) crescxcry a vew) eas Seren bride eireeraig Peer serene emer etentroen eee Peorrnrercrer) Saree ee ier eee poner oe ee) pee Saeed cae pair reie aea eT enntinya aos al <2 tim > mount of ys satu. He hashed 2 6-k9 (13-1 weight los ring 1's pede He emigrated om te aide Est ‘oun 2 yes ago ater eed of ng cancer athe age of 54 yeas. He has smoked ote pack of Courts daly for years. He appears malnourished. his temperature 261°C (100.67 pubes 10min an bond presrre in 118772 mm crac are ard on auscutatin ofthe chst. Carclac examination shows ne zbrormales. The soma sf and nontend.Laborsony sues sh ke Hemoglobin naga tsa coune 335,000 rm! eye sedimentation rte 66mm Creag oo mgiat Lay tein normal lt nay fhe chest shown, Which fhe folloming the most apropit nest tp ‘Ths midal-aged patent migrated rom an fe th ahigh prevalence of tuberclon (TD and has figs on ches ‘ray tat alse suslcon For reactated pulmonary TS pal cavernous lesion ard ros patchy inves in appr lung fis. The symptoms of productive cough eve, nd weight loss mean that acne pulmonary werculesis “a Sputum utes ar the gold standard or cagnosing ave pulmonary TS and for esting drug serv. The aterom Beal <2 +0 > a Sputum cuts ar the old standard or cagnosing civ pulmonary TB and for esting dug sent. The ater ‘esses and fae negates se poribl. acaue there ns igh index of enpcon for athe tube nh patent, he shuld net war sputum cure resus before sarong empl Weatment -Ahgh-teoltion CT ern of he chest oul be poorest farther aaa pulmonary proests (sone ha are pote cancerous) This patent’ chest xray has aeady ponide Sint edence of pulmonaly ning canssten with Te. Fures imaging suds ate not necessary ats por (ra! eatsnacn canbe ued for outpatient eaten of caneuniy-acqued preumana. However, the chest ray Fics Im pater ana the fae hat he Mas msratec om an ates wth a igh prevalence of tubercles make pulmonary TS rot hey than CAP. He shouldbe weated for T, for wich oa levloxacin would ot be appropiate ‘The araiss of sputum specs the east and last mvasve way to confrm suspected ace pulmonary T, Patent wt Suspects acive TE are equa submit spt specmers, ith each on ue fr culture FB sear COSCOpy, aS rue acd amplicon, The last to tet af seal for apiay ening active iberelons acteral cute a Neesnry {oconfim te cagnotis ana fst for cru ene. By Towra ‘Transbronchal lung bps may b considered im tert wth pumonay lesen hat ae suspicious fr pulmonary cance. Is animasve rocedare and therefore nt outnly done 0 confirm 7B, Bronchoscopy wth rochoaveoar vege coud be eer ae ler en eprom of oar isaacOm Be al <0 > ‘a! ead ca be ued for outpatent eaten of conmunty-acqued poeumana. Homave, he ces cry haan inthis pate nd the fect ht Behan grated fom an area with a igh prevalence of tbercoss make planry TB ror lay tan CAP, He Should be weated for Tor whch oa levoRoxacn would ot be aoroprite ‘he aralaeof put pccmene the eat ni ae nvave way to confi spaced av pulmonaty TE. Patent th Suspected act Te are requvedto sum 3 sputum specens, wth each on ued for CURE, APB Mea MOSCOY, a rl acd amptcation The ast wo ests ar seu fr rap Meng active eros, ace cuties necessary {confirm te dagnon and test for cg sens. Bi Taneraists “ansbrpchal lng bopsy may be consdeed i patent wih puronay lesen that ae suspicious fr pulmonary cance. Is animvasve procedure an therefore nt routinely one to confirm Te eroncoscepy with brorchoaleola lavage cous Performed butts sully eservad for when suspicion for Ts high ai ter matods of coniming te Gago have Combinaon weapy consisting of onaz, fami, pyrazinamide, and ethambutol she weatmant af he fer ace ‘uberis forthe Hot 2 mont of weatment a shouldbe stares enpicaly active nections suspected. Homeve, tater on " ‘a treron-garima release ssa canbe used oclugrase let TE. This paet has Nadags tar potty ace acne "5. His ereon-gurera lab any eld mot ky be postive but not provde any atonal formationOunss ‘On arta hes severe pan an breathing oily, Hs pulse 135 rn respons re 30min, ad cod pressures 50/40 Ho, Theres at impact wound he fourth intercostal space a te manly ie. Auscaven sNews ‘hess hace vine ae. carcae examination snows no sonore. “wo toe-arenravenous esters ar ice lrdiravaous ud essction Degen, Which ofthe flings the most ely agonist? be le Brome pte (© Temsion preumetnorax|522-yarld man brought tthe emergency department 15 minutes aft faling7 eet onto afattop wooden poe eapiaion ar 30/0 EOD “Tate a ioact wound the et our costal space a Me mia ln. Auscuao shows “here ER we tk cer ‘Carle examination shows no anormalts. Two age-bore mravenous careers ee paced {ard invaveous fi esusctation 5 Begun Which ofthe followings the mos hey lagnoss? Waa aaaninnaaaeacaaeaaaaiaaiaeam 2a 2 caractmponade may present wt cya, chy, and hypotension as Sen i ths patent However, nck veins rot be present nan oad case of cardiac tamponade. ‘once ropture would preset wth subctneousemphysems and hemoptysis Clncal eure ofa preumethorx such 2s hypetresonan lng els would alsa be present henry oeeeredn data achesbrnchal tie ype Wachesbronchl {espn Th ance of any there Godage suggest ferent diagno= oubs al Sys + 540) Q 4 ‘onchalrpture would resent wth subcutaneous emphysema and hemoptysis. Cra eure ofa preumetnorx such 2s Iyptesonan ng els would also be presanci te iniryoccredin al VaheoWoncha Ue (ype Uecheabronch trai). The abence of any thee ings suggests ferent Sagres ‘tension peumowrax may present wh acerca, chypea,ypotension, deceased beuth Sounds on we acted ie, Imedasoal sift tat occurs win tension pneumothorax compresses the superior vna cea, so ung Hes nthe fered ide woul a nypertesnant instead of du on percison ‘al ches could preven ih rgprary dss and tachypne, A patent with al chest csily ems parade ‘movement of pat ofthe chet wal op rxpration, butte sgn may be been dat erpatory eng. Howse 3 rmedasral sit rachel deaton), decreased best sounds, anda dul pote on percussion ae nat chaacenst sis of @ Ma chest. The absence o bony cepa also suggests hate pale Jos not Nae a Nace Geen ag hoss MUS emotbarak can develop flowing blunt chest vauma. This patent exhibits al he sins and sygtons at masse hemathora, se, tachycardia tchypne, hypotension ft reck vis, decreased breath sounds and alles om percustion| onthe fected side aswell as wacea evavon tothe opposte side.Sel ermine uses and Nas vomted once The pant as no Cough, Houses of ino: Me Pad Sia Symptoms ane age o 5 years tht resched spontaneous, Hes eters heal) is temperatures 279° (002), Pulse 85min an blod pesure 103/70 mm Hg Hea ad neck examination shows anathema phar ih ‘pvishexudnes cera te pln tone. Tere np mpnagenopety Rapa artosncecnon efor ‘ioup A strpeocce a ragatvs Wich othe flonng fs mos appropriate nex sep athe Management ts aan (© | essere of attaptn er eassuance 2 oop a io weeks Measurement of areal capsid arin iM antibody ) obtain throat cuea a . id ouns al ‘7p oy erg he py fr teva of EI oh pt 2 as 010m pedo hs ha icin ues and as vomited once The pate has no cua hotseress one He had sar Epps aria ae yas teshed poacher ney. a temper #375 000, felicia tasd remore 108/ 7. nde eek carat sows fron aes ora eine sno lymphadenopatny. Rapid anogen detec test fr Sevpasreaca i naune Wracho olonng is most appropriate Next sep nthe Management of hs paten? ke ec tons 2a < Anrepoyin ASO) ter mess esp fhe orp for squsan of sreptoorcl ines e.g uma ves 250 ei or seul in clagnosing acute seprococal fection cause annbody lvls a about 2 wash oe ano not peat unl 2-3 wees alr neo, arsboay lev rai pas rater than crn feos, Ths pant as ony been fymptomatefor 2 dye Therefore, an 250 ter woul iy bu negate, even fh symptoms wate du fo sepocora Ineo, esstracs and monitoring ae indicated for patents mh ral tne. This patient rus Fra texting oul out acorns Before monitoring is ndcated as fale to wea bacterial fons chien increases Werk of ‘eumanefeve, poststregtococcallomeruonephrs, a spread of inecon eg. pensar abscess. ‘a anual api agen gh aves used to dagnse mononucleass ia pants wth cancal susp despite a negate ‘monowpt text Win patents wrth menomucnct he hae srl chery ths pate tng fre pte Such cervical mpnadenopsny, fever, and hepatospenomefaly Moreover, smBtoms Spy Occur Mm adeescers and9 Eo ‘an ancl epi amigen gh nl sud to agns mononclesin patats ith nical suspicion despite a agave rmonoepot fst We pcs wah mewomicnoi oer hee trsln/ tery hs ptt cng farther mos ‘ch as ceueallymptadonopuhy, fue at hapsorlenaresal Moreover, symptoms peal secur it adoerera an Yeung acuts rurtermors, a monospet tests te fst alagnestc stp before aval capsid antigen 1M testing would Be ~ Fein Vis the eaten of choice for in patents without pein aegy. This paver requis Further esting befor ‘Ths pabent has arate onli and no signs specially suggesting ara lines (9 conjuncivis, hoarseness, cough, ‘Neva The gold standard for hagnetngboctenal tonalite a tres cake, hich can em the caring paogen {nd deerme ts anton sensi. Ciaran and adolescers witha nena aid sreprcoceal angen detection Te Souls nave a ea cure rule ou bacerl sfc up fo 20K patent are missed Wi apd anger ceecon fering trap antigen tering and ott calture sponte, ante therapy ceaec bacteria fection led out (Len both anogn esng an core ae negate, obsention ane smptomatc management (gy ¢eammepren or NSAI) ar indeOunss productive of moderate amount of arenish-ellow spucu for 2 day: During ths berod, she has had severe malas, {ls an aety beating. Serashyparension.nypercholstlema, aa tpe ? abees liu. She has Smoked tne park of egncties daily fo 20 yore Curent cicaions clude sires appr and mfr, Tempers ‘om sr shows an oxygen saturation of 8%, crackles ae head on auscultation ofthe ight upper lobe, Laboratory tides som eukoyes cout of 1200 /m?, an entree sedimentation as of 60 hun anes nitogen of be ) Supa weatment th moxtoxacin (D) outwanertretmant wth aienyin ane aoxsein-csanae (© | veer resent with astiroryen and ceftaxine ICU admission and administration of anpiciin-subacam ad evoloacin| (W) epatert weximent we cevanone (1) 160 aimieson and administration of seers an evood ons Fe eoepe reeinreny rhea aneereg priory ee eet bed paririnainioint erent er poner rerrans Peeiemneeopeaeey iy crsod onsw & ouns al | BFE woman brought ote emergency depamen or proaucove ef moderate amour of for 2 day Duin this periods she has had severe malaise, ‘ls an aety beating. Stehashypresion.nypercolstlema, ana ype ? abees lit. She has Smoked Tare pm Har 0 Care ci er seca re Tea 1S (102.27, pulses 110 mim ‘and lod resus 143/88 mm Ha Pulse one on ‘oom ar shows an oxygen saturation of 858 on ausetation of he ight ppe lobe, Laborer ‘ude show easy coun f 12200 an eytoctesecimentaon ate of 6 mm/h an a utes mtogen of ever “Ts pater presents wih fev productive cough malas, ils, oyspnea nd extensive opacty ested toe upper ae eee ee (CURE-65 sate in he 67 yrs Lane eesti ate 33/5). “a ‘Outpatient etme wth monnacin recommended forthe West of cormmuny-acqued preumonia i mchduae Hosp adission sina incised nts patient because her CURE-65 scores 2, but another therapy 5 neaded Cefepime ‘euvaly used or nosocomial necons wth paogens such es aruginosa sures and’ poeumonie sShonych ‘HfecineagamstS poermonae and aypeal gems Cetamiin effective agaist gram-negative barter 7: dammehaha ak Tile Ads sacl x Stee naar as a anmamade dhaes P aeedaadacaa hs eculaat Tees name ecoua ll 2 aeruginosa, They are usd in combo 0 eat poeumonia when #2 aergioss i suspected. Ts pet has 9 sk factors fr serpions infection suchas trent fein lang hora ay vetlateg > da, srr! ng cheeses, IcU azmuson einstein patents wth evr erpatoy flu, ep shck, of decompantation of che sytem hese like chon renal ocardac disease. While the combination of cfiaxone and aevomycn ay be conseed fr tS pavers preumora Sn ds not present wih esues a Would ware ICU aamsson. Outpatient tenment wth arthvamin emoiin, nd alana recommended for tester of ‘corausy-sopeed formosa nda whe acors cach 2 eae ante eto pressing mula enon, diseases of eal rs or ing in ntsing homes, ad 2 CURENSS Score =, Howes, his Woman has & (unas score of? and cupatent uecimert wl tis combnaucn wil tear ot be appropri Inpatervezmen wth 2 conbinton of a macckde and an antpneumococl besa. atvonncin and Cefotanie) indeed in pater th communty-acsutedpreumona anda CURE-6S sare © 2 Hospital amision and mimeo ofa espa feroqunclone eg, levflonse) woud aro bean appropiate wesen thi care Since ‘his patent as ne farther complications or rak Factors such acne respiratory fale, spi shack, o decompensation of Comorbaies, non-ICU management is posse.Breer ICU aomsson is incated in patents wth severe espatoy Tau, epteSheck, oF decompensation of ether systemic hess Sisson otha ‘utpater wetment wth aztiamycin alone 1 ony recommended for he weatment of conmunity-acqured pneumonia n ens witha CURE-S5 sce s 1. This pave has @CURE-ES Score of 2. osptalamsion saad ths patent because Nr CURL-S5 sores 2 but ante! teagy need. CeRiane like micoplsme er Chiamyel,which require edonal empinaltresment. . {CU adsense patents th evra espa flere, sep shck, or decompensation of eh tert nest like chronic cara and vara eases, The combinaton of avzonam ad flan ud to eat CU patie with fneutona who ae alg to peiciin nd in whom oudomonas not suspected. Ths ple doesn present wihouns al <7 iw > ‘ hours-Two months ago he noice ams onthe ah side of hs neck and ws Sagnoses with large cance He Mas Sime wo chs of grees dal fo 27 yeas. He rks to Pas of um day He appes I Hels ovetea to son pac, an tine. Hs temperatures 37. (88.6, pube eI min, respeations ate 34min and aod presse 8 130/90 mma Pls oximetry on rom ar sows an ongen seurtion of 89% Examination shows a 9c, tee, subalac mas onthe igh se of the neck Ceri! Nmphoderpaty Is presert Hi resting Is bored and he has. Feo 453 mmo fos 74mm ag Hoos 25 meq eas no advances deci. Which ofthe foloming Is the most eppropiate nxt step n management? “a ® 1B) Tracheostomy Invamuscula epinephrine a6 + keouns al <7 iw > a Cee ‘ hours-Two months ago noice armas nthe ah side of hs Meck and was Sagnosed with large cance. He has ‘owed oo pact of grees duly fo 27 years, He drinks two pn of um diye appeu I Hee orened wo - Peson pac, an tie. Hs temperatures 37 (28.6, pubes min, respeations are 34min and aod presse 8 a 130/90 mm eg Pls oximetry on fom ar shows an ‘samnaton shows a 9-em ender fm = aS Bas epee ben Pon 74mm Hs Heos 25 meq 2 eas no advances deci. Which ofthe foloming Is the most eppropiate nxt step n management? a W 1 ae 7 ‘A wachea stant may be weed to mainan tracheal patency following surgical reteton ofthe peten yn ener ~— Homer tachel stents dono provide a contol away an ate Not paced athe bedside fo eat ase Fespratry Is managed. Theteore, (percutaneous or ope) wacheostomy is the prefered nrveron becuse wl provide en away that bypuses the tumor and can be weed for ong-erm mechanca veel,oua “raeheorony is inetd patent ho wl eure long-term machaneal verlitin and/or patos wth upper away bsreton causing respiratory sss. Tas pave wl ikaly need longer way manaemert hie is aya once Is managed. Tateoe, (percutaneous or ape) wacrestomy i the peeved rveron becuse Wil plow ch aay tat nc earl a ced eee cee ese 9 By. Anvay monsgemnt and velation Inramuscular pepe i used or aca araay compromise do anphylasts This patent has netbeen exposed toa tigger for aneahyins eg, mesa, food allergy, insect te), Rowever, an lara ter symptoms fans ear thing, angioedema ‘omfrecare measures may be appropnate ater on the management ofthis panes cancer, further ae i deemed fie lore requests palate cate, However this pater pest ith ce Yespratory BSUS and Yas ne avanced ec, so Cccotldetmy sna in patents who requ emargettamporay away maragerent and cannot be nubaed (2 onranaieeton or fale of endotracheal intbatnWhle th patent equtes unger tasy manager, hes onze Fesponsive, and hemosynamcaly sable anche wl kay nee long-term 3 weeks) meena verelation ven the chon rau of his away obsuucton icthyedexonys wot cated for long-telm mechanical venation Furthemete, Seeaae ths patents aya! assis nthe aubgltic regione the re thee an endorachel abe ul be needa 2 eethyonctomy), 2 ereethyronoromy wil be comands,Bs al {52-year-old woman comes tothe pyotanbacaeofnceatng shrines f beat nd 2 non-proucne cough for 2 mors Se hasbeen unable to perform er dy ae. She as had las and ate are pain during his ela she rotied er symptoms ae unin Wom vacation ozone Shee 2 esa SSP Ue UNePy ey acre creay Men et fri refer Ls 9 rl Her temperature 37.8 (00), pulse 100mm respratons are 24min, an Boo pressures 112/72 mm HO use ‘oxime on oom a shows an oxygen sean of 4% Ter Is no palace or allay Imphadenapay. he Shun heh ofa folowing ve moe ey agro? “wcodois ypesenstivty paeunoniis Hodabars mohoma “ranlomaoss wih pangsbiesotenevasrentie)> ouns al {52-year-old woman comes tothe pyotanbacae of for x irre era od a ela she roted er symptoms ae tuning Wom a vacon ozone Shee a esa SSP Oe UPNrY (rstogynboatory. She oii orm IM ond vit fay there tn yor her lest ip wes 3 moet age Her temperature 37.8 (00), pulse 10 rm respratons are 24min, an ood pressures 112/72 mm Ha use ‘oximetry on oom a shows an oxygen sean of 4% Ther Is no palpable ceva or allay Imphadenopay. he Hee ew fr meni ce eect or ly renee otc Tre ec tre Shown hch of eFolomng te most ie agnosis? “The chest sray shows rece epacues ad ilar aeopathy, Wc ae Consistent wth et pulmony Tangs Pumonarymcvemert the most coro nal nding ofthis daca! Adora, he pter has aterar et, (OT ach acer in abou 25% of patente wn hi and “a ‘Panay symptoms ae te mos common icing in acu 5e0K0S5, nd Sully cle soreness of Breath and a teri ye oe fc oe esc ich ecard et sre ean grow. “Th pave comes fom a geograpic ares where ubrculsis endemic, Pulmonary werclsi also presets th yspnes, Te ere een tae ee an ee cee eae eeoua “Th pave comes fom a geograpic ares where ubrculsis endemic, Pulmonary werclsi also presets th yspnes, Tels borcre od esnigh b thc ow e rtbterelecs Mrertraty 1 camo festr eon on ayn tubercle, bt eta pacee woul ot be expert. Tuberc woul aher auseacaletied ranloma (on compen Lath eventhough wberclesis ca fect the skeleton may the Sine ‘eke atalgia's exttemayurcommen in cubercoss, ‘honic hpesenstuty oneumnis may present wth werseing dpa, non-productve cough, malaise, and etcular opacies 2 cast ay. Hower, alga and aa yipadenopathy ar play Mt See in hypetenseutypreumors. ror the tar ymphadenopathy, non-preductv cough, dyspnea and malaise maybe al signs of Hodgkin's phoma. However, ‘he abuence fd aymztoms (2 fever weight ov, ight ave) anrmphadenopathy ater tes eal an roca neds) 2 well ath prosanes of anormal comple lod count an ahaa (not peal asocated wth oda’ tphoma)suagest e diferent hagnoss. etalon may rent wth epres nan-pasucte cough, male na iar rphacenepaty 2 en nti pater ‘rvalga may ao be presen in aout 510% cases. However, ts pent doesnot come fom an endemic aes 9, Cho, Hlsisipp and does roc have aor of exosute ots obs (eg ave exploration, Adsl, acre ures sable tenner‘honic hpesenstuty oneumnis may present wth werseing dpa, non-productve cough, malaise, and etcular opacies 2 cast ay. Hower, alga and aa yipadenopathy ar play Mt See in hypetenseutypreumors. ror the tar ymphadenopathy, non-preductv cough, dyspnea and malaise maybe al signs of Hodgkin's phoma. However, ‘he abuence fd aymztoms (2 fever weight ov, ight ave) anrmphadenopathy ater tes eal an roca neds) 2 well ath prosanes of anormal comple lod count an ahaa (not peal asocated wth oda’ tphoma)suagest e diferent hagnoss. etalon may rent wth epres nan-pasucte cough, male na iar rphacenepaty 2 en nti pater ‘rvalga may ao be presen in aout 510% cases. However, ts pent doesnot come fom an endemic aes 9, Cho, Hlsisipp and does roc have aor of exosute ots obs (eg ave exploration, Adsl, acre ures eit cecil Cranulamatons ih aang Quegne' granulate may paren with cough, dypnes, mala, and anhalt, at Seen inthis patent. However, the absence of upper espretory Vt seas (ed, suits, ots media) and vena disease Suggest a een agross.Moreoe, il Iymahadenopaty, wich seen ths paler tcl absent pantsa 4 ‘Ths queson spar of sequence of questions. Answering ths queston wil unlock he follow-up questions Hower, You Won't be = ale to change his answer 25 son a5 You hee ened the folon=up question. ‘28-year mans brought othe emerancy deparmant th shortness of eth an cas pain, 35 mines afer he ‘espiratons ae 33/min and hood pressure 132/88 mm HPs oxsmety on Yoon a shows an oxygen saturation of Qs Sh aieatonstoms mule abeasions over ns abdowe and evens Tee's 25-am (Ii laceration one “The abdomen i soft and theres tendemess to palpation over the left upper quadrant Bowe! sounds ae normal His hemesjobin concenravon 136 9d, esky court 9,110/mmP, ond patel counts 190,000/ mm eres ay be @® Diaphragmatic eupare Esophageal perforation (©) renner pyvACray een teehee eS eee aea Paper eeneiy oto) ers eer remnney preeonreamend operate Paces Serre ry seer eed aes Poca arene Se pease eee caCray een teehee eS eee aea Paper eeneiy oto) ers eer remnney preeonreamend operate Paces Serre ry seer eed aes Poca arene Se pease eee tn the haawos s ‘Ths queson spar of sequence of questions. Answering ths queston wil unlock he follow-up questions Hower, You Won't be slo change his anor es son as you have vewad the folon=up qusson 2-year mans brought othe emerancy depres wth asminsaterme ‘espiratons ae 33/min and hood pressure 5132/88 mm HPs oxsmety on Yoon a shows an oxygen saturation of Sh camieatonstons mule abeaions ove nis abdowe and evens Teleis425-cm (Ii laceaton one Ise ofthe heat. There ee ST CRESTS. Cre examination shows nostra, “Te sosomen sft ape theres eneenes to sition oer upper quadrant Gowel unde ae rma. ne hemesjobn concemraton 1369/4, echo count 101mm and pale counts 180,00 ER AF tuna anda ceses-ray tat pel fortis conaon. ” Za s2(A) Diaphregmanc ropare w Disptvagmte pre most commonly cabed by ponerstng res run sums such a igh-sped tor ele Celison. cn fatresnsbae che sodomna wal ees deceared bemhsouner cu one atin et acon) events th rest and vespraony tess al of ch re sen neh ignete Sometimes Nowe ounds may De present Inthe thro Chest woray nally performed and may sho duplacerent of abaararal organs int the hoa and ‘Ciopliegaac mapa dowd dn es aeydipeas:ouns al Esophageal perforation may occur in a varity of cnc Scenarios eudng Soest syndome, blunt and penetrating chest, ‘rauma, and avageicesopnagedl perforation fling endoscopy. Pavers wih esophageal pefraton preset heat pu, ached andachypea, sn ths puter, However, he ono fen aceite wh dito nge Such fever anceps ovr the nest ceo recasinal erhysera Une wth aber & nesta Typ ShOwS ‘idenad madam Hermation ofthe stomach to se tora Is ot yea asacated wh esophageal petro, ‘equted forms of eaphragmanc evertaton are usualy Wlopanc cause by phic nerve yy A chest xy Shows findings thacmayreerbetoce of hriation of abdornal cote ote thorax ain th patent. Homers, luphragratic even rater an eutpouching ora normal levation af «parton of he hemchapragm ands haateraes by setened cnn he saphagr Furthermore, th endian nla tenures olouing ‘tiauma ad more conmoriy develops inl fer en mate damage | peumedteras ca ecu spontaneously folowing uauma such as 2 igh-speed moter veil Coin. atest Present wthtchype,yspren chest pn and unsterly reduced breath suds, sae nth patent However, elem fhis ware, achet3-r sual sews 2 hurl ne, 2 suden change radolcency, and an aru Stop Im pulmonary ascularmalings. Ths patent's Xa fangs aero consistent with 2 pneumothoas. ‘The phrenic nerve imnerates he dlaphragm wa he nerve oot C3, C4, and CS, Prem nave palsy often topes Totwingsupatavcur lcd) and may ocastnaly occur Tolouing ama: The conan ads ipsa elevation te ‘Sechelt el crn ct ates preset il presi tc he pte aeOm Beall <9 i> ental eegeete reyhegeal perce fee Our G oeieeeegl Peacoat meptogea etree pre e chest oam, eres and achypea, 5 ts patent. However, the const Is fen secre We adoalMalngs Such fever anceps ovr the est ceo medasnl erphysera Unie hs psi, chest ay tpl Shows widened mediastinum Hernation ofthe stomach ta the thorax ot eal saceated with esophageal Plone, Acquired om of pragmatic evetation at uSuly lopanc ocasea by phn every 8 chest Atay Shows lophragatie voto ater ah eupouching ora total lation of 3 pron ofthe hemciapesgm ane Characterize by preserved contin of te eaphagn arthermore, his condn Is lily to cer mesa folowing 2 trauma aa more commorty dears ioly ae hen nate damage. | paeumothers can ori spontanesualyo following tama sch va igh-peed motor vel calision. Patients pel present wth tachyprea, sone, chest pm, nd unser rece bret sounds, 5 Sen is patent. However, nik n this wane, a chest Sully shows 2 pleut ne, Sudden changeinradohceny and an abt stop in pulmonary \aseular maligs Ths patents Xa fnainge ae no constert witha aneurin ‘The panic eve lrestes he apvagm wa he neve 00 2, C4 ane C5. Prec neve palsy en togEDc ed wig srt ec) wed ery Scary ero Floste mi: Te ete ets teed etc ct tlapeage eich aoc plenary aed cra: cin, Patents cn privet with Grapes Soe on pte hoe omer, ay usta shows elation ofthe aphvagm on the flected side and not hematin of abdominal comnts ito ‘he mora, a Seen ns pater.Be al < wri > ‘Ths quesoon spar ofa sequence of questions and nas unlocked by ansvanng 2 redous Eston. ‘A rau hud calles, Morphine s administered or pm, Low-flow oxygen epi A trauma claphragmn repre is suspected. infusion of 0.98 sainets begun Wich the folowing the mas appropriate neXt step In @ teers © ches orscopy (©) crete chs abdomen, md pale (©) icv asmisson and obeeacion © tmervency sae (©) Veo essed thoracic snery WATE) (©) Nat cas an abdomenouns a < wri > o ‘Ths quesoon spar ofa sequence of questions and nas unlocked by ansvanng 2 redous Eston. & ‘A mau hud calles, Morphine s administered orp, Low-flow oxygen epi A trauma ce a (RUE Suspension of 0.9% sles begun. Wich of the Following the mos appropiate nex step Ghent “ ‘ 2 ‘baru sallow may als be used co confi suspecad diaphragmatic wpe by showing abdominal contents above ie tluprvag However, barium saw tests rat oultely ued inthe dagosis of waumatcGaglagmaue pute, athe roca lenger nd less pecs than other process and raqurs th patents cooperation. 9 ‘es socoscopy maybe nated Tor suspected peice pay or condensing ceased ung east) (a. Inertia! ang tenses However, tha patie presents eh signs an symptoms suggertve of laphragmat rope, and Tis cest ray shoud be Followed by a erent and more specie mening technave to comm te dae, ‘ACT of he chest abdomen, an pei ste most appropriate nex step nthe managemet ofthis patent, who's suspected ft naing a traumas apnragaticuptur. Xray hangs alone are ot suite to estan aphvapmatc rupture asthe {trae dapnori ay nly show nec ig fhe npr Moreover, concomitant inj shou be fled ut ET ‘wou be abet cect wsualize te contr of th afeces hemephragm ard confirm te diagnos Inder fans Include rickening ote sapragm eleraton oF abdominal organs, and heriaton of abana Contents tote theseCe ea Ly Serre) enna Perr nareny oe or Porras ee ere See ee, earner Ney oper etna) paar eer Rete peebein tae ee eee Perea een errr eg ren ersCe ea oe) enc Perr nareny Leonel eatery ee ere See ee, earner Ney Piebpeees cretarneeany paar eer Rete ee eee Perea een errr egouta < ria > CU aamisson ane observation without any utr ntervertion woud be 2 nappropiedeson for is pate, who rere confirmation of the daphragmate rapture and subtequen Suge ‘rergeney surgery che Westman of chien patents wth conrad caphragmatic pur or hore who are hema unstable However, hs pate sheiodynamicaly stable ard on had an aay the chest hich not Suter wo estabish a Genie aagross. Tertre, the paver in he gt should uncergo The aghast estng VATS maybe pesto wo obtain a Biopsy, resect arc masses, o eve 0 epar a caphragmatc apluen some CSE lun of he cot and abdomen canbe performed for urpetd apap ny 2 abl to rectly eu the Atscominaty ofthe aed erapivag, wich would confi the agnosis However, MR ot he geld stander trauma patents since Bere are eter imaging eeiqus ala ater and cosa ei. the petra contmatonyOunss < tia > incresing cough fever, ad sores He hat type 2 aetes els, hypertension end dere, Curren mediation Ire si, eas and onepez On aval he has spread is soled ome ace, an Bran. HS tempera s 38.C (10067), ple 113/min respiration are 25min, ae bleed pestres 78/50 mmHg. Pe “pimsty on 30m ar oi a sy gen seston a 7% aucun snows fre creer over he ran ana el anda examination sous an Sy, Inavenus uid esuscaton s agin es ibe, mechanical vanes, ad Ievofoxzc. m spe of appropriate tery, he isthe Fling day. Which oF he folowing woud mosey Be ound ‘on cram stn enaminaon ofthe pat sputum? a be 2 “ramcnegan os G o 4> ouns al < tia > | So-yatlt man brought tthe emergeny department rom because of 22-day hor ofan rox inceasing ough fevey nd dyspnea He has pe 2 abet melas, hypertension, and deme, Curent mediators Irie si, eas and onepez On aval he nas spread is soit ome ace, an person. HS tempera s 38.C (10067), ple 113/min respiration are 25min, ae bleed pestres 78/50 mmHg. Pe ‘met on rom ar sows an angen seuration of 77% auscultation snows fuse races over her ua el anda examination sous an Sy, Inavenous id esuscaton sagan es ibe, mechanical vant, ad diac shouts. A norspnephrine fusions begun. The patents admitted 2 dee of ravenous cafersime and levofoxzc. m spt of appropriate tery, he isthe Fling day. Which oF he folowing woud most ey Be ound ‘on cram stn enaminaon ofthe pat sputum? “his eldery man had fever, espa, cough and aches xray shown nfitztes, which saat of preumona. The JF mosecommon causal engantm of psamonia sian ofongtem cre ais the same asthe ne thats Oe eee eee ee 2a ‘ram-ngatecocobaail ae clssc Gram stan ings for Haemaghins nPuerzae whch sa common cause of ommunty-acqued poeuvona. Honea, rs notte most common denies bactenal pathogen, No findings en Gram sta oud occur namical preumonia fom pcopasma pnemonize or Chimpdoohitepreumonie DAypilpreumcna seveopsessousl ands usualy mide than ypc peumona ome pains a asympiema, wh ters experience low eer, Necache, mle, dry ough, aber xtapulmenay symptoms. Th pet a pe neumona tS on smptoms of cough, eer, and dyspnea which are severe enough require hespealzzvon. Campos coc in clusters ate classe Gram stan icings for Stnhpococusaveus ich can cause postenza pneumonia trough bacealSupernacuok. Theres me erin of spat having Mad We Wh Mg Tv ee Ee, att cite ate ceca eeeouns al Campos coc in clusters ate classe Gram stan icings for Stnhpococusaveus ich can cause postenza neuron cough bacteralsuperfacvon Theresa meron ofthe ptt having ad he Mu wih igh feet, chi, ‘ere mast, o ont a muscle pn dae to wes roto developing pcaronia © aussie Nt the most common use of preuonis resident of longterm cee faces. Crampons dislacoel at asi Cram tain ning or Sppecocurprsumonian whch he mck common cas of pneumonia among resents of ng-term care alte. §eumonis ao the most common cause of Conmuny-acured Peumona aces a age runs ram-nagatve fos on cram sta cou nicateEmrobacenaceae Suc as & co Keds preumoni of Peuaoronas atte i agape rar ea er ay ee per uy ‘Spades prntmens: aeragaratenycaure wntatr-crocte previ snd spel common pons wth {ys flrs. K preunoma commonly responsible o osocomialetons i smunoompronised patents. over, the ofthese rgansms ste most cormon cause of preumcrs among esidems a ong te cae Tales.Se ad Coenen) Set neee ea Seeieceee Ty Peneenpieertc one eee leans aesCram-pasitne apiococ ate casi Gram sta nang or Sepacocaspoeumonie wich we mes Common Cause of Preumona among resents of ng term crocs. &premonars ao the most common cave of onmun‘y-acqured neuron ares a age rus. BS Q 3 Pecunia ‘ram-ngativa rds on Cram san cold indicate Enarcbacenacae such as cok Hebe preumonig or Prudemanas lerginosa when can alo cause pil preunona, Peanonia duet € cas maily foun in neonates ox paves with Spiaton preumona f aeruginosamay cause verator-ssodlatedpheumtia an | especial common patents Wh ‘ete Slr preemie commonyrerPort for emorontl feos i emamocmpromtved ptt. Heme rather of tes organisms ste most common caus of preurcna among resem of long-term ae facies Crampons branching baci ar atic Cram tn fining for Acar Pulmonary nora x most commonly seen In gains with obs tons pulmonary ops, Wegere renulomatosi or inaoaeicency Ths unuSil og3Sm may cause ecurantpreumoria but is pate Mas hse thereat Nca/Sals rot the ost commen cause greumantouns a < 2ri0 > nie forte past 12 Nous He has not had fever. He has bent the emerge depart 4 ines dung the past 6 mows tor eaten of ata exacecatn, He 3-moni)-o1 seer was wened for rors twee a, athe ae a ‘ess, Hs temperate Is 37° (99.7, pubes 101m, respratons ae 28/min and Boos presse : £5760:mm Hi, Examinaon shows mld intercon and suas vtec. Planar examination sows deciased Bera fhe chet shou hyperueaney ofthe ht lung fal wih deceated pumonay ating. whch of be ‘lowing the nex ber sep mananemen™ ronchescopy le a acm enep ving G rote na OG +aos al < 2ri0 > > forthe past 12 hout: He hasnt ha ever. He as been othe emergency deparnert umes dig the ast S months {or resumen of esha exacerbations i 9-onth-ld ler wae wrested fr bron week age, Hs fara ‘sess, His temperate Is 37° (99.7, pubes 101m, respratons ae 28/min and Boos presse 5/60 mm Hi, Ekaminaton shows mld intercon and suas vevecons. Planar exarvnatn sons ERE folowing the nex bes step maraneren? long wrth ypercencyof th ana elas, wrich imate a foreign body aspraton (BA) wih bal-vateforegn body e ‘stuction Half ofl FB occur hdren between the ages of? and 3 and BON of cases valve the ight wan “a Fa] Needle thrasntmy 1 tanson sumone is suapacte, emergency nace soracostny usualy paced in the scona iron spe ong ‘he midcavar ine, Tension peumtores can present wth yaptoms silat the ane seen the pate neaing| ‘eons, acypren, ands cous wl second beth sounds oa the affected ang. However, te canon tan - ‘solute emergency: somptoms are usualy more severe than thls att ad afe often assoated wi) Sudden, stain & Sues er cha on mats cect ty Nay hs eel sue ge nore consent ith 8 ¢ ee ees sunremarable petra, bronehorcanyspaud os petomea ah surest Isles sbecte ne Bet erie Oy "igi bronchescopes.Fsible bronchoscopy le the Geld anced the agnosis suc or te lacton othe foreign body Ps aoun al a ‘Aatr!sused nthe a of asthma atacs orn he management of COPD, This att asa hstory of asta and indeed presents with symocons ofan acute astima ack such ae shormecs of beat, exptoy wheezing, deceased Death sound, Sst symptam mteat ne ung re mere coarart wh Fo Inte apneghns ie amintve n moderate to evre coup Croup affects patois btaen 6 month 02 yar of 2g in areuar, the aproximat age the ster here, and offen presents wr dyspnea ard cough Bi the cough has & Pel baking character ands ten accom by osise voc, lon-gade fre, i spraory Uo, ae No reser inthis patent. In ontast ots ign, chest xray ypcally sho subglthc narrowing steeple sige. Th patent cea {Cr ofthe chest woul key eve the exact location of the aspratesfregn tod However, while the forean ody cannot be vised vey based on spate s ry. hypegcency of eight ang ad se daca pulinonary markings ae Fangs that areny stronly suggest FOA Aatiionl maging woul ot nluene the management ofthe pains canon. ‘Azivomycin of sed to ues anil pneumonia, which cn present wth symptoms snr tothe ones Seen in his len, ke ry cough a shortness of breath. However, atypical reumonias commonly assocaes wh extapumonary fears such fever, fags, headache, cre trot and myalgia alse, auscultation wus unrmarabl and ches «ay ‘wpaly Shows aise reevlar apace Ths patents cnc frags and dagneste maging are more SUQGESe of FA,ouns al < nr i0 > |5.20yar-eld madi iden come othe pyc fora chest raya rule ou act pulmonary ubeeon He ‘ees «medal and aiogcl ep: before Staring a mel incenshipn South Aca He has No istry f Serious Iness ana goes ac compla any symatoms. Hens smoked! pack of gues dal forte pas 5 years. He does rot Cdk lahat He's 190 am (6 tall and eight 75 (65 Is) M9 20.8 mt Hi terperatre 37. (SBP, pals 8/min respons are 18min ad bleed pessres 126/89 mm Hos Te uns ar lear fo auseutaton. anda examination shows no abormaltes. The xray of the chet shows ral peumotore i of 2 bance 2a ‘iets moracecope surgery Emergent needle thoracosomy 1) mec bation and asied venom gene est tbe placementouns ul > ZI |5.20yar-eld madi iden come othe pyc fora chest raya rule ou act pulmonary ubeeon He rox oem ‘ees «medal and aloo esr: before staring rel incenship in South Aca He has No istry f Serious Ine an He as Smoked 1 puck of cigs dal for Oe put 6 ye. He doesnt _ Cenk lahat Hei» 190m (6 n)talland weighs 7S (65 Is) Mn 20.8 mt Hi temperature 37. (SBP, a pulses /min respons are 18min ad bleed pessres 126/89 me Ho, Te uns are lear f auseutaton. = arta examination shows no abormales. The xray of the chet shows 4 ese Ghent ‘The cra stoma smal poeumomorx i of <2 cm) betwen he ung magn and the chest wal as an ncn ‘ding. na tal fond smoking young adult hs suspinus of primar portaneous preumothor os 2a Ww ‘eae oraozcopc surgery wou be nce 4s a aernatve uesumet fr tenon preumathor, ofr he ‘eure of spontaneous preamatorat.Eeaute he pet ony hat 2 al preunatorse ad In hemadharaaly Stale, ne equves a aerent aprcach. eee ‘regen ese thoraottoy woul be neat nth ate of use siden chest pa, dspreacyanoss absent beth Sound, hemodynamic sabi, and wathel deat on est ray ‘Spontaneously ihn afew days (~ 10 ay‘inergent sae toraostony would be indicat nthe cate of tanslon pneumothorax. A ransom psurothorex would cae sudden chest pan, dapren cyanosis aber reath sound, hemacyramie natabity and tathel deviation on eat ‘Observation wth follow-up seal chest x-rays ae the recommended tresment for this part becuse he has srl primary Spomaneous preumorhorax tht does nox conpromse ns gas exch uncon. A sal peuemora kay ese Spontaneously ith afew dys [= 10 2a) Immediate incubation ad assisted vrai isnot inca forthe management of praumeshoax and may even worsen ternonpreumatora, heh rgures decompression provide etaled information about he cause ofthe condton, However, tis patent’ lagross has already been established fra turer agroste easton ox insted chs tne Urgent chest be laces indicate for 2 smptomatio age preumetiarax Gr of > 2 cm betwen the ong ‘musgin and he ces all on chest fay ut span has 2 sl may sportneouspreuatra ads ‘SymptemaneBs al < ui > has sorress of reth. On ara es alert and oer time, lace end ese Ms pulses 170m respatons ‘se 22min and lod pressures 104/70 eH ule oximeny on room ar shows shone stration of 99% wth each espraven athe wound se here's ne uguar verbusAstenton. Trees hyperesorance to BeCUSION re ‘created breath sounds onthe eft side etches et the midine ich ofthe flings he mos spproprate nex za ®emervene thoracotomy (© Observation © (©) tonerescony Fehocaroarephy ©) (chest ubeouns al < ui > o a has shores of retort he ler and oremed one, lace and petson- Huse NO/minespuatons {te 22)minand los presi 18/70 ig, Pe xen on on shows a nye stato of 98 a vt sen epravon sth oan Tee noo venous saeron. Tee 2 "ne achas ate mine Which fhe olonng the mow appropiate best g “The presence of dyspnea and tachypnes with decreased breath sounds and hyperresonance 1 percussion after & Oe stating chest wound win ubbing ood nats an pen prota. The heady by, ing Be ee a cee 2 “a Eneiganeythractomy sated for pats th pening ches roy ae ate hemodyarically nse on al nd nresporsive od euscata, or ho have been ui ad een OR or <5 mes ace spe W ‘Sectpuracay stl hvac dd s0(@) Fart occinhe dressing v 2 paral ozcisie cessing gnu ape an tree ses ve he wound temporary eaten for open pieumothrse eee ‘ed spree frthar expansion of the penumethors unt he agent har been oni snd defi ater tube teracostomy, surgery axel The essing works by ecduding the wound ding nspaton Bian’ the oun) Te open side allons ato pass avo he wound on expiton,oua al < uri > ‘bservation i Sometimes considered in vaumapatets who are ety stable with orethal iis that often Sl-esohe {ea small primary neumothoran-e pavers shor of beah ard has signe of otertl la ur on exam, ach Lanergency prcrdocentss is ncaed fr pesca eusons causing hemodynamic stably, aac tamponade) Aloug thi patente 2k for eae tamponade (pentting horace aura e's hemosynamcaly bia an encarocertets wold not be mdestea ats time. Adnan, avn Ms oer fcngs on Pra exam, a ernanve ‘agro mor ely and vqures immediate intervention. =} rnchoscopy the ts of choice 1 cate acheoboncal ee ity (TO. APIOUQH ts patent could have TB Ecnocarlotapy is par of e FAST exam, hich sea the pnstting vauma primary tamination. Te _iSrecommended approach to taunaesscation Fallows the ABCDE alga iray ~ resting Caciaion ~ Disabiy exposure ~acunctv ets (e, FAST exam. Ts psn has away orathng lures whch requ estment bere esscaion can cominue othe adv eaters, hough echoarograpy woul! Hay be perfovmed on this patent he as another jy that takes precedence in aume resusctaton and regues mediate erentoety eres ee eee teeta rlaged ee shovete (cooear mater bore-shape ue posOm Deal < ui > enchorcpy ithe ts of choice t ani acheobronchl re mjuty (TO. tough thi patent cul have Te choearotaphy pat of he FAST exam hich sedi the penetrating trauma primary examination. The [ari-ecommended approach waunaecscaton Fallows he ABCD agai lay ~eresting~ Cwcuaion — Disay expose ~ ache est (eg, FAST exam. This patent as arwey eating res ich rau weaomen betore esscatoncaacominue othe ance eaters, though echocrdogrepy would ey be performed onthe eda tractor x tpery, alligator ii peurttorat at comes heey stably ‘ough this pavers certainly ats fortron pneumothorax Quan is peratating chest wound hes cer remoajramialy se ° ‘chest tube fe thoracosony) is th dafnve ester of choc for avant wh pan onsumothres Akh his pune oes reque a des ube note taizing measure Shou be peformed st wl Ms ill Wawra essairete poten Co edrete poten eedBs al < s+ i0 > | soyar-ld man comes tothe physician beaut fthoat pain ad neresng fic swalloung fod forthe part 5 mors He hs also had episod le ex ain forthe past 3 months, He has hypertesion. Hs ony medications aniodpne Hs Taber cea of xyigeal cance atthe age of 55 ya's. Hea smoked one pack of gues dal for 2G yer He dis 2-2 beers diy, Vital igo thn nora Int: Exarnation shows ket cereal peop ‘ropnarygeal examination shows a3-cm ukeraona le tonsiar mas, Examination of beth aUaor canals, Stramatabe acho the flowing ete mos appropri nal step in management © setasoscery (@) Nascomayngoscony (© Fanensocony © tayrgoscony ke> & ouns ul < s+ i0 > | se-ysar-ld man comet th pysctnbecuts f voat pin ad crating fcuy swalowngfood orthepat (GI Smo He has also aed ear pin forthe past 3 months He hs hypertefson Hsely mecca “rope. 4s tater dea ot ayngel cancer athe age of 5 ets He has sled one puck of agus Ja oF 3 year teins 2-3 bers uy, Vial gn ae wth norma ents Examination hows Ee aS ‘tconnge| xaninaton sont Sele leant. examin st oor vote, ana = Semarkble Wich fhe lows the mos appropri nase a management? ‘he prasanes ofan ulcrang leh toile mass and crvclImptadanopaty nz any smoker should ae upon oF crocharyngeal cancer - squamous cell cinoma (SCO, n particule 2a < eel ree re effec eure rae aa ‘own mass onthe et toni This mass is suspccus fr eropheryaeal CC, and should be evaluated further, er pote primary tes oF Cc shou denaes a el bu ase may nt be Hed fhe esephagus ‘Nasopharngoscopy wo hap fre value he known ass on terns and asses footer nasopharyngeal meses ut oul net lp ent ather stent primary ates of cae tne fhe manson. Fenenosopy allows fr comprehensive evaluation ofthe ent ype aay and geet ac. Tee he Mor apprope In stepmevalung suspected oropharmgea cancer because ke enbls assessment of te extent ofthe known timo 3 Walls other primary Stes of cancer. Ths pater has brown sk aor or SCC, and Dep Would ao be taken ing oFw outs al © ‘Nssoparygoscop wut lp ute erate KROWn mS om the tna nl aes fox oe sopharyrgel masses ut oul et Help deny ether ptental primary ater of cancer ata ofthe nanophary Feneneropy allows fr comprehensive evaluation ofthe ent yper aay and geet ac. Tee he MOE approprte Ina step nealing suspected oropharrgea cancer because enables assessment of te extent ofthe know tumor Wala ote pay Stes of cance. TS putt has brown sk aor or SCC, ahd lepies Would ao be akan ting oF ‘Atasum swatow is used to evaluate gasuonsophagan eu, e545 stu ot Maal eri, orient te cause of essen vertigo dyahagis. However, te eae ofthis patent's eephapa has alread been ented trae ms) [ie paton as carcal ymphaenepthy sed knewn nk actors fo orphaned! 3, farther wtp of he onl tet a assessment for other masses nthe heal aid ack agonist Laryagescopy woul lyases any concent masses inthe yn but oes Re alow fo exluan of the how masOunss < ria > 2 |A3s.ysar-ld man i brawgh to th omargenc dparment cae of cough ac poor apt fore pat we snco (GG ae irbega, he her been coughing up salanoums of malodorous plea Daring te past mo ngs he ha so had ‘ugh seas He was daghsea with HIV tec 5 years ago, He has peterson, ye 2 diabetes miu, and Sve a yrs. ears 6-10 bere daly. He empetear fe 18° (100.07 pute = 1, min esienons are 25 min and : ‘ood prassie 145/52 rm The patent sppens naked. Fhyscl examination shows cacles ad loess 19 fice secon murmur ard long the upper ight sen border. He Co4°T-lymphocys coun 289mm? -_ ‘Normal > 50 An soay ofthe ees shone nay nate nthe dah ower una a hich ote fllomng ee c mostly aus a Bis patents symptoms? a © sation pneumonia ® (D) sronetecn (© Mayngoesoonagea anetteouns ul < ria > a . 1 s5.yarld man brought tthe emergency departman: because of cough and poor appa or the pat wesk snes oman icbeaar, he hasbeen EO il ANGUS MIGGOTEUSENEGR. Owing ve est wo night he has also had gn swets, He was agnovee wit HIV tfecton 5 years ago. He Ras hypertension, ype 2dabetes metus, and severe & eee eh ee eee et = ood pessire 145/22 rm, The patent eppeasironcated. Physica examination shows friderytle jection mut i ard slong the upper ght stra order. Ae Co4*T-ymphocye count 280mm? a {ormal > 500. An x-ray of the chest Shon fly iat IRREEIOMEERIE, which of he folonng ithe : most key cause o is patents symotors? g “This patents ings should ase concern fora dsease caused by decreased gag refiex and atered consciousness. ee oy 2a 5 se ‘Bronchoalveolar carcinoma adenocarcinoma tn sa nonimastve type of ung cancer wth aparcular growth pattem {steed 2s ei. rary ae seas, es oa) ings nce solaly pera rede but 9 mre aovanced e Furthermore pains sate prosentzon, fer and lack of system symptoms of ing cea (ugh lac, haope, ‘nd fu), make a deren dlagnos more hay ‘reamocyospreameona [FCP pneumonia 2 common opporunist ifecn patents wh MV an te most common use of death in patets wth IDS However, FCP preurona meets with a ry cough us itera! dy cece, end Inertial preamania on chart say ante this patents ndings, Adora «CD curt > 200 elem mates stagron le ay.outs < ri > Cough, malodorous phlegm a fever nthe Seting of laho se sr de arte history of seer hatbut ate suggestive of aspration aneurin. This pens chest xray shown aha inflate the ight nes arg Fd Frher ‘Supports thr agnosis, onscreen nk factor for arpraton at cele sen in ieoha buen, Ceneral anesthesia and slaves. This stent’ stow of gst eux san aol sk ator for aspraton, es Ges lower esophageal sphnceroytuncon, which can ead ote ragurgaton ot gti contents io the exophagus ‘onchiecasiss mainly een n peters wih cst flross andor recurentpumoray infection. caren by pious mucoparlet sputm in cntast os pater, who has smal aowrs of melodrousphiegm,Furthamore 3s cpposed to ths patients nary inflate me gona lobe, bronehecescharatrticaly appears "am tack bes Tuberculosis 7) usual presents wth eer ané might swess, 25 sean mths ster. Although akonl2bus and being homes are sk Tato for development oF Te the Subsite ons o cough probe of aioaorous pie s mare suggestive of deren diagnos, Moreover, chest ray paint with che TB shows upper Ibe carlson, whereas iad ps eign nine ay tere ested pee Te pent SI el rate ee] best nerd along te uner ng tral borders Halt be duo gore stenosis mal reputation causes aumorary ce, which canbe etd on ausctaton as bisteral caches, whereas hs patent has aie loaed the igh lower lobe Furthermore, tha patents chest ra ngs, ever and acute not of symptoms are more suggests of ert© O Dera <5 + 40> 9 BS Poeumonia ‘onchectai maily 08m peterr wth eit fossa recurnt pulmonary infections. te catecttzed by opous mucopuruen sputum In cntast ots pater who has smal aout of malodorous pheom, Furthermore 25 opposed ots pais nay iva nthe ght lower ob, bende characters appears 2am ack Bes “uberone 7) ual presents woth eta igh sweats, at sun thi ptr. lough akohl abuts ad bing homes are isk facto for development of TB the subacute ons ofa cough prod of malodorous phlegm s more Suggeste of dere iagnoss, Moreover, est 1a patents wlth ache TR shows upper be caviar Ison, whereas Mal yp epi anc a lca bet em i Ur apo The tent 2/6 oy pen beet hosd slong the upper nigh ral bode = Wal tobe a ozo tenons. ial epurtaton cures Demons, dea, which canbe heron ausctaton as bisteralcraches, whereas hs patent has rae oa 2ed tothe Mae ower Tobe Furthermore, Ms pan’ chest ray cigs, eve, ad acute nse of Symptoms are more suggestive o erent Pranegcesophaga deriaum (Zanker deri protnt wh fou-ameling regurgitation of wget feed. athough this patent ass cough productive of maledorus phlegm he des ot complain of oes regurgitation Faves with Pharnooesophagealdvertculum usualy compl of Sysphagia ada seston of having ump the toa, hie sot Present ths patent Moreover, fever ab fague ae not explined by &phanngoesopheges| iets alone2 wetks, Tee was oe eptode of 000-cnged hid caring fam the nos dung thi paid. She hasbeen ‘mou brething aM sles othe past ys, She was bor a am, Het1-ye-ol fate ma eae Wa (estrcentrts 3 weeks ao. she i at 6" perce for eight and a 70 percent for waht. Mer temperature 37°C {56.60, pulse 95min respons are 23min nd lod pressre 95,58 mm Hg Examineton Shows mucopurlnt ‘dacharge inthe et asl cn. Oral and ooecpic examination i unremarkable Endosc exarunaion ofthe nose Foreign both ewracton fom septopany (© Funconal endoscope sins surgery F) Aasno.ectomy«> omnes al < = eo a oem ‘There nas ofe episode of lood-nged fad drain from the nest dug Wis period. She hs een mou btething a Mesos othe past ys. She was bor at am, Het 1-yea-ol fhe es Heed To (estrcentrts 3 weeks ago, she at 60 percentile for height and at 70 percent for weight. Her temperature 27S {9860 puss 951m respratons are 25min ad ee pessire 596154 mm Ha. Examination sows mucopuralent ‘dacharge inthe et asl cn. Oral and ooecpic examination i unremarkable Endosc exarunaion ofthe nose 3 ee 2 2a ‘Tiensnase! puncture and string are wed to ueatchoanal aves, congenial conan aera chownalavesia usually esens nary, whateas te unsteral frm presen arn ew CMON Mts of the ete nasal pusage The w timeframe of he paten’seynptome makes bilateral esa unlksly and undstarl atresia dost not peal presen with ae foutsmeling or ood-ongea nasal erarage. S eee ‘Tumor embolization sed to est juuaemzophanngel angioma, locally atv area tumr tht ypealy Desens with etsodeepstanis and asl ebsucton. This ch ony hed a igloo of Bood-tnged fh. As, these {umors ocu etal excusiely naolescem males. ‘eth aniatera natal ehatge. he unatrasypome ae 2 ky ing at many ofthe tereri ugrors (eg, eve ‘hinsirwsts or an upper esptery act infection geneall cause iat! symptoms The foul sms due oalacl naar cea, ich can ale progress to tec, The agnosie eaablened va drec vaudzaon of te reign ee ee ee oe ee | eeomnes wl ‘A foeign as! bey should be suspect nay young id ox patent wth neta! or benaviorl sabes peseang ‘oth antral nasal discharge. The ater! symptoms ate aay Fang st many ofthe diferent sages leg enone ‘rinniuste or an upper erpatary wet fein) gery eau ltrs! stom Te fol sel duet sae Inflarnator reaction, ch can so progress to ifecton. The agnosis sestablshed via det vsuazaton ofthe foreign body using aeadgt etoscope, oH necessary endoscopy. Ramoung the oot body st atengted Oough peste a» A septopasy can be sed 1 covet a asl Septum deaon. Moe severe septum devon can cause situs infections, seep spots and toring The patent oct not ave ay symptoms tat woul supget snc infection (eg, eer a head ‘ough mout reat septa thre sno Mor of ston gor anes. Functional endoscopic snus surat i used to stress vetlation and function in ates with onic sims wh have fated metal hrapy, Past ith pcaly tron suits est with betel mueoputlen drainage fm the nove ce ‘he atophanan, atl sngerton fal pay an Impaled saa faa Secass tis patents syste ate Inconsistent with vrs smut, ths procedures Ret nakate, ‘Adnotictomy fhe tatment of choles fr patents wth symetomate anol vegetations whe zen hypertphy ean presen sna, th mucopurulen asl icnerge and mouth beating the discharge wvalynonblody and affcs both ross lo, the enlarged adenovds wold have besnwsvaliza dung oa examination.a) ey rt Seer aieaeerateran) ey eres Seer aieaeerate penopeeren retoun: ‘A septopany can be ued to aetna septum deviation. Moe seer septa devon ca cause sn infections, sleep Spots 2nd mnonng The patent ose not ave ay symptoms tat noua eugget snc fc eg, eer ar hese ‘Alrough mouth breathing sept thre sno sory of Soring or apnea. Functor endoscopic sous surety i used to restore sus venlaton ang fncton in tents with chronic sinus wo nave fated meal therapy. Patent th pay hone snusis rest with lateral muroptulen drainage fom the nove Se the asepharns, rasl congestion faal pa anor Impaled Sense of sel Because ms patent's symoToms are Inconsistent with rors musts, ths pocedues noc ndiate, ‘Adenotectomy isthe treatment of choice fr paterts wth symetomatc adenoid vegetations Whe adenoid mypertophy can presen slay, th mucopuuer asl rege and mouth beating tne charge uvalywonbiody ana acs both nranasllucocrucod therapy can be ues to Hest allege atomotor hints or natal papose Rn generally presente ith eter Symptons. Nal polos ae thought co devi inthe Sth of onic ammation inpatients wth conan Such sale sinus cyst tos of asthma. TMS pant Sos wot have a Moy of Such Sk TCS. Aaa. pop are move common i acsor ss ets agieed He as pain in hs wpe vita hich hi cradling in ike ar es terperatr i 38.7C GBT pulses 125/min resptatons ate 25min an iced pessute is 165/20 mm Hg. Hs beahngs shal. Pls oanety (5 100K oxygen anon-reteeather facemask shows ap nygeh stration of 62K He's conned an ond ont freon txaminaton shows mute ries on me ight anenor neat al. The pupie ae equ an este th Sn inspiraton his ight chest wal demonstrates paradox inaard movement wile Ns ie chest wal expending ‘hares pants palpation and crept over ha igh anarot re. The remainder ofthe cxariaton shone mo soormaltee Ary ofthe cote thoun Tes lnge-bot sae laced After ud fenurcaton an aaigen,which . {fe olomg 1s ne most appropriate ext ep management be Faerie ofa ches ube © nest wth ponte prottte venation = (D) cr scan othe ches (© spel fantom of igh the oscead contusion eee eetmos a ets agieed He as pain in hs wpe vita hich hi cradling in ike ar es terperatr i 38.7C GBT pulses 125/min resptaton ate 25min an blood pessute ic 165/90 mm Hg. Hs bestngsShalo.Pulse unety ona errs sens men on of nr rr ot On inspiration ‘hares pants palpation and cepts over ha opm anterior re, The remainder ofthe exaraaton shana me storm, BYE hun ge bora pws te anata aie which be ¥ Rear an spn nnn os ed sn an ow a cs, z ee eee ee ee ee eee ae Terme eth respiratory stress thas ot responsive wo 2 Supplemertator? This interventions requed = 60M of patents {amized owe hospaa wth Tal ces. 2a on(R) Macement ofa chest be Tube toracostony fe ndcted for pnumethrex or hamothres, oth of which an res fom cast aun ad may be ASsodued with Tal est. Howe ths patents chest x-ray was Death fox bot emothorax ah preumetor sid. Hemooraces ik al pleural fusions) are ually oly apparent on chest xray Whe are > 300 mL. They appear 5, ‘ured costpwenic anges, a homogenous est with« mesa margin, andor a complt "ahi ou of hemor sith mein shit avy om the fasion very rl =OM Deal < ria > 2a “Tube thoracotomy indicated for oneumethorx or hemor, Bath of hich cn res om chest ama and maybe Ssodsed with Tal chest. Howe th patents chest x-t2y mas Death fox bet emothorax ah preumetor@ Sie. Hemotoraces ike al leural fusions ar sully oly apparent on chet xray they are» 300 ML. They appear 5, ‘ured conten anges, a homogenous rst with« mesa magi, andor a compe "ahi cao hemor vith meiatina! shi any rom the ion er rel dorachel nation with postive peste vention ised in pteres wth al ces who bare estoy dese reactor to ronmvasiveassanc ep ac mask, analgsiah This patents hyponc and tecypree despre Deeuppemenatan, hich mane he rues endcracea bation for respiratory suport before he progrsees 10 Fesprtary alps. The fal segment nt breathing by moving agent he normal there wal nih deep Breathing Secaus of he pam accompanying cert nll expansion Porn preiure venation erect arith vention sear Splint eff on th al segment, both of which prone espaon, Bo eds thoracotomy nea a at eat for hemodynamic unstable patents ho have savers peneting oF Hunt ‘horace vauma or hemetrorax and splay worsening rypotensionéespe volume resection o oss of al iN. may BE Censored when exsanguinstng hemorrhage, cae tamponade oa embol ae suspected anal oe measures Nave fate slncugh ths patient shows rexpratary compromise and equtes urgent erento, thorscatamy no an appropiateae Cr coer perenne Esetae Cr coer perenne EsetOG Distal leached ih es pein estos eed in tics th Rid det ar py ee restr to nonvarie ane (og, 2c mas, anlgesah This pater hype 2 teypree despa (eSuppemenaton hich means he reques endvacea Iubation fo respratry support before he progresses 10 ‘esptatr colapse. The Ma segment ts bezdng By moving agent the norma thre wal a WMDs deep Breathing because of the pa accompanying cher nll expansion Porin presure venlatin ec arite wth vation ae hat 2 Solna effec on he al segment, bath of wich prove esprave. Bun eda thoracotomy sna as at eat for heme unstable patents who have severe pentraing oF Hunt ‘hora rama or hemethors and pay watering ypoteson deep volume once ot ot fal gn. may BE Considered when easanquinting hemorrhage, cae tamponade ora embolae suspected and alae measures have fatea, hough te pation snows rxpiacry compromise and equresugere rv, tharcotomy tno a appropate contusion ori ries) and may be consdeed for this patient’ workup ls, re genealy shows nib fractures more eibly than a comvenonl cece ray and may Delp open sug sabilstion of we Mal sgrene, indicate, However, te Paton win sever repratoy dot ham xygensatuation of #2 deepte ong suplementton ans theefre Fequras immesat tren btorewansport tT scammer wuld be consiered. Surgical fixation no reunly performed for store wth fal chest and would not be he re tp management ofa ater ith resptatry tes whe Goes vt espon to Cs supplementation, nations ide goss chest wal deformity {ed ralure owen «pet of mechanical vera, wteh would be a sign that mechanical vrai aloe des tot‘ports tha he whiting is becoming louder, andi especially lovd when he exeries: He sys hens i rusvatg for hme Sb months age the pant underwent cugater eset fot 2h uncomsucated nasal acura! beng The {symptomatic nasa alps temperatures 37 (58.7 pulses 70m espravors ate 12/mir ana Dood pressure is 170/70 mm bg. Physical sxarsnation stows no abnoruates, Which of he fllowing would have prevented te za @ nasal septal nematomesramane (© Anionic herapy (© sexopasy> i@ 2 w & ouns al forthe pat 3 wash He rox ‘epons tha he whiting is becoming louder, adi especially evs when he execs, He Svs thers i usvatig for fer bing ii se hm, Sbe mers age, te patent undenent te pe bik lol Sey acl. tlre pete Pee yer pa cbc a Psy of {symptomatic nasa alps temperatures 37 (8.7 uses 70/ma espravors ate 12/min ana blood pressure 15170)70 mm hg. Pysel examination shows no abonmates. Which ofthe fllowing woul have prevented the “This pater rests with 2 mes whiting Sound 6 morhs fr sustaining nasal face, suggesting nas sepa perrorauon. “a ‘Nase sep perforation may develo 2 Sequel of septal hematoma secondary toa nasal ace The hematoms srpts loos fw ro re septal atageresuting n chem, across and Subsequent perfor. Atlgesis With atplaee! tty sucha uptin yore the devsopen of trauma or surge Ts patents prolonges pan ater natal mur may aso bea sigh of compleatons Suen as nasal heaton ‘rd perforation. it nas spa aration aspiain ad rine sou be perorad imeaay to rece Fa Bh Micetncows e(@) Nasal pop remora Sa Be a reHematoma of the nasal er)Hematoma of the nasal er)ouns a < ria > ‘tough the pate as 2 istry o asl pols, pay resect sual have peveted re whiting, Sigal anova of rasl ply ony incest ne pain symptomatic an awa with topcl a sateme glucocorticoids = Unsicessusymoromanc nasal poh pial preset wh 2 pesmasal ia, lateral nasal bstucvon, ard requerty Iyposm or anosmia: the presence ot asst with whistling Suna “anibctic erapy in ombratin wih cio and Gamage sated patents wih Spt absces. septal abscss most, ommonysevalopesecanasty tox septal rata (gd toa fei trauma, a seen nie pion oneal ead to Sot pertoraton However, septal abscess is are completion of nasal mur and woud usualy present wi asl selina fd ebsrcton, wren ts pain dows ne Fp. hinopasty may be performed fr aesthetic or freon reasons (ey obseuced breathing de 0 congentl nase etormiies or waumay However, is ot aaa fr me preveton of asa Septal prota and may eve Cause I onditon arpa emstors ort Sepp i nceates to core natal taptum deuston in patents with pronounced neal fining auch a fey beating, headaches, rfc pan. et ndctd forthe prevention teatment of asl septum perforation and may cen pecinate me development af sept Nematoma an subsequent Septal perforate,x (le ar en ar eee Peery ted Peon end pore ironyonuped < rim > o ‘pat ogi here pe 30s tig wd trea cs. ce resin snd pun sarah co sig vtec pum wr hha ben ‘eon al oe semper sR GUT, pe 0)mm spats emma Bed & 1-2 em lacerations and ecchymoses over the face and trunk, There is no neck crepmus. There |s a pocket knife im the night foutonul spe se ner aay tea Bd ing ot the dT mobbing oe Dd Fgh thoracotomy le e G cr sen ofthe est OG +> & ouns ul < rim > 15:20.yarold mal brought tthe emergency department 20 minute afer sutanng 2 ab wound othe night chee Fist-espenders found he patent sng onthe cur smoking a ciate compaing ofp wee We had bee) saboea On anal he alert Ms temperature 36.6 (8.77, pulses 110m, esprazors te 16m 20d Wood cor aa eye oe ens Te ec ce. OE ‘eA whe acer asilr ne and loo dosing out ofthe mound Tere sm DDN of Di “poroonate nent sepn management? ke a ae 2a “ ‘nae thoracostmy slp meregeney wentmen of patents wih atesen preumathoray, which an be eae by lang ry eto peneosting rau, A patent we tension pneumothorax wil ave hysotension, Jug ven tenon, ‘ahaa destin, and aban exh sounds wi Pypaesnance to parsson onthe pst si, Ts patie sms ‘be weacostony Is inaicated in pats wih Remotarax a preumothorak. A hmotocat wi Sutin decreased oe beat sounds woh hyperesorare fo percssion onthe staal ste. Ths paver has normal breath sounds Waste. ste hfe’ slo stu, the exert of ivathoracl damege is unkown Although hes caren emdmanically stable, the ave could nave cause asl damage bats simply tanponaaing ne tab wound, preventing Neorage at is Une. ee ates ee a aR he ME asouns al < ria > ste hfe’ slo stu, the exert of ivathoracl damege is unkown Although hes caren emdmanically stable, the ave could nave cause asl damage bats simply tanponaaing ne tab wound, preventing Neorage at is Une. Upon emoning the kf, the pater oul hamarhage an rap deterorte. Emergency sgey ented ormave 6 lee man enuionmer in nich leeing canbe cone, Terefee, he patent should unaerao rap seauence endaesimubatin ina pain of ener geny SUEY. ‘ceorrldeomy is used paves wh requ emergency aay ortecvon once other nterverins hav fad 0 secure the sreys. The most common caus larygospesm, a obstruction tet prevents ss vasve away management. While Shep eer gy emer attain ere ederim st ‘htc fray manager te pater who oer oot hve any wadenc of lanes fa toy shone of beat acypnes) ‘chest CT scan wou be ep co agnase the exc of mur in stable pen nh penetrating chest rau who does tot cure hee penetrating os tay place. However, he at thal he ei sil mito presentation and the othe eign body. Thaefre, «CT Scan sou be postponed ul folowing surgery. ‘Ths panenrequres emergency surgey to remeve the nf n corre enaronment. lange mas aways nt ‘ypclly used nthe seting of emergency auma surgery sks sabe sry than other oonManagement of penetrating errataoua rl <2 a0 > scold nave outed scl damage bute amply tampanadng he tab wound, prevntnghemorthage hi ne ‘Upon removing the kite, thepatert oul hemorhage an raply deteriorate, Emergency Suge ncsted 0 remove te knee an enucemer in wich blesing can be conlea.Tefeoe, he pale should unaege rapa sequence Crcontldcomy is used i patents ho requ emergency aay ovtecuon once oer Ierverions have ald to scare ths peter requres emergent surge to remove te mst kf and manage themes, cathy rleotamy snot te Ht ‘hice frst management hs patie who doesnot have any evidence of Inyigospasm (sido shoress cf. breath, enor) ‘chest Cr sean wou be spf to dagnoe the extant of mr in stable patent wh penetrating chest au who dss rot urenty hee a pene eeon oa) place However, the tha he fe sl mss on presentation ard the restctay hing nating atthe kre acing sa tamporase nthe Wound Necessatesereger petave removal ise Eth herr CT sea shld ce lar tee ‘The povenrequices emergency sugey wo remove the Kn na ontzled emaronnet A arygel mK aways et ‘ypely ned inthe seg of emergeny tame surgery aes les sabe aay than other oprOunss < 1352-yar-old abe man brought tothe mrgancy department 20 minute afer he was invoked na igh-spaed motor vehi cols fe mas the vesainea driver, On aa ei ethari is puse e112), espana 1oymie and wtegular, cn ood pressures 94/60 en Hg. PuseCximety on room a shows an enyge Saturation of ‘ver face, ces, an aden rath sounds ar cease over he flung base. Two lrg bre perineal verous ‘ators ae ised and 0.8 sine infusion & begun Rapid sequence maton stated and eadoachel Intubation atenptes without sures dag ard mask venbation conte Pulse gumety shows an onyoea "Strston of sik The patent hae no advaesdrectve 2 famiy members hae ot seve. Wh the flaming the ‘nor apprograte rex sen n the mananemee of me patent be (@ confor esses ot (© | rte © creowwetmya ouns al < iw > 1352-yar-old abe man brought tothe mrgancy department 20 minute afer he was invoked na igh-spaed motor vehi cols fe mas the vesainea driver, On aa ei ethari is puse e112), espana 1o/mie and wregular, an boos press 1594/60 Ha, Paseoximey on room a shows an enygen saturation of ‘ve face, ces, an aden rath sounds are cease over he flung base. Two lrg bre peroneal verous catheters ae inserted and 0.9 sine nusion begun Rapid Sequence mba st ag ard mask vention contiues jane dtectve spa famiy embers Have nt sues Whe of the fallong he ‘ner appropriate ret step n he mananemee of patent oo “a ers wrth afc aay, However, eots t assisted mutation shoud ony be performed If exrgeraven hasbeen be, can't oxygenate skunton wth inceaing hypoxers, dequsely niin oxygen saturation > 308 or bein te tgh 88) Ths panes onygen stration acutely ecompensing op fom 31% to 689 espe atempt at bagvave mask vetlaton. Cerebral hypoxia may enoue an amp etblohng an aerate army wa vo laryngoscopy uncut moter sproach i prfrrad in an ‘Ths panent has ust steed aor wauma and his prefered code status Is unknown, would bh maporopnate ro ke ‘hang is de satus to comfort metres nlite absence ofan acvancedectv, 4 hath as roy, a efoe all EEE ee ee ee eee =ouns al < ia > | Atraceostomy sa elaneylenaty procedure for satis who have been iubstea fo 1-3 weeks and sl require prolonged mechanical venation, a nproves pate comfort and ceases the work of brething may as reduc he ‘eepratry dives = pata ites) mart be entablthed. though srl tay may beets, eacvoetomy would be {inappropriate ecesque na emergent sting Such ath withapaien whose respatory function aut ecompensing. ‘A nasovachesl approach may be attempted forthe purposes of endoachelinubstion n patent th aif aay, cust by the copays. Hone! ts wcigu Is usually peor i te operating oom unde Het vsualzaon of the pany nt lnngoteopy. tough apissaquencemubuton has aed in he Patent aapest non ater th lermaosconi assstance shuld one performed onyenation has been adequately mataned oxyen saturation > 90% lortab th igh 6s) Ts tent’ oxygen Stuaton saute decompensting (top Wom 91% to Ban) despite MPS 1 bag ave mas ventlatn, ‘hs poten has ut steed aor wauma and shows ign of espatary ness reapraor eae of 1mm. onsen Saturation of 36, eurclegcal compromise defarge, suansh pup) and a compromised away Geresed best sounds ‘vere hashes, api dscoase In oxygen seat) Establishing a secure aay she st step in the ABCD algo trauma manegerent surge auay with cheathyotoy ahold be etelnhed in patent who cent be inubates and HtH Ey :Sel < «> ‘She cd ot ose consciousness Ov aval she has severe nck pat she sppers aus Het temperatures 37C (98.57, pulses 105 mi, respeatins ar 25/ mi and blo peste 120/70 mm Ho Pulse oxime on ro a Inthe nah posterior cerca reon ofthe neck. Theres no ext wound, Carooa pulses ae palpable lateral, There ae ta cares, Srsaton to npc ad ht touch normal Te hngs ae car to ausutation. Cadac examination Spromnte net sesso manager i pate” 2a @ supealexpiranon ‘ct anaoaraehy 3) Baum sallow (© semagoscepy ©) tayraescopy (© Crestronw & ouns al 13 51-yar-ld woman brought 0 te emerganey department 23 mines afr sustain 2 ‘She cd ot ose consciousness Ov aval she ha severe nck pat she sppers aus Het temperatures 7C (98.57, pulse 105 mi, respons ar 25/ min ana bod peur 100/70 mm He Fuse oumety on a shown wt oxygen satrton of 90% se cited to person, pace, ad ume. Examination shows alt etance wound iow Sere iene ext wen. “hereare carci ruts, Sensation npc an lft touch noma Te hngs ae caro auscatation. Cardiac examination pmo nent sap the manayeran of he patent? ke “hi woman sustained a gunshot mound wo the neck nd ae sale val gn with no igs of acheal or esophageal Ne ee aa a rele tected Gecisre 2a Surgical exploration sincere a pauens wih penazaig neck uy who show Sas of decompensation an expanding hematoma or achelarophagal iy. though th pant x ztyeatac ad acne rot kl tox sympathetle respons © pa shes normetensv ana as nermal oxygen Satuaton. she also Rs 9 1" of expanding Femstoma, ‘ibcianeou emphysema or ongoing biseding.Consqusnty urges exes hex cated ats ne. “The pant has suffered «gunshot wound othe neck bur presents wth stele ial signs and anormal phys examination ‘ale pans wih penetatng eck juries should be evaluated fx posible incest the aches, ayn, ad neces Muttetector CT angiography he recommended maging macy for he esalashon of heen ‘gunshot wound the neck may reque mtubstion, most common bacaue ofa eaceal mj fan expecing neck hematoma tat empress the aay. Th patent inthis anette does no have an expanding hematoma nd as no SgnsDt me a art ere meen eco a tf nV eet hematoms that empromiss the ses. The pate nth gets door nt have expanding hematoma a ha no gre of tacos nur (ea der subcutaneous emphysema, mops) oF fespatry sess er Wal ns ae Sable, she really tact an she as roma’ oxygen Stain, other mo inaton fr endeachel nubaion. rtm ao may be an aprox forthe cagnosl of esophage nun hough penetrating ncknjnes can cause sophageal iy, hs pant snows none o te assocaed san e-.,o}Shagia, hamatenes, subcitareaus emphysema, Fo baum salon sy would ot be nested adn, tae gh suplon af sophagedl perforation 3 ‘water-soluble conras agen such as gastoaran) Is Used mead of bau, Which can cause medasinOs. sophagscopy san appropriate test forthe dapnoss of esophagel injury pals wih anegee arum swallow study of ‘ha ae unable opartpae a basis alo stu. Athough peta teck nurs may caupeeophagel ny hs Paton sous nang of the asoeated signs (og, ephagla Rematumens, subcutaneous emphysema) Laryagoscapy maybe indicted forthe agnosis of occ injury to the yn ut not the preferred mil ingnostic rmoday m poten th pancrsing neck mur. Moreover, ths patent Goes nt have any sgn Fanngea ye, Serdar, cysponi,henopes. ‘A ckcotyttomy may be requed i the patent ism resptatoyasues and roche ecubaton of supraitic vention va laryngeal mest cece fl The pan doesnot show ay sighs of respiratory des, MOUBs al “two day er undergoing 2 eft otal hp replacement 2 68-yat-cld man ha inctatng shortnae fEreath nd chet bain for 30 mires He has ye 2 sete melts and Data exteoarhits of te Nps For 0 adnion to he espa nis meaiatens wate maormin and natoven. Hs tamgeratue 5 37.°C (1007, pels 110/mi, vests tt 0 min and Hod posure is 106/70 nH. ult ormcty on roo rakes an enoen stration cf 82K The long te caro sucutatin. cardiac sxamiition some no abnormates Theron ower eset woe. ME {oot fevion nan upmard dracon cases pin inthe ight cal. Pedal pulses te palpi, Supplamerta oxygen and peo: 37 mmHg Heoy 2a meq | slearoariogam shone smu events an rgnt cation. hen ae fling ee mee sppropnate na Stepin te management of is patent? “a Peter compression uteatonostaphy ke © Adie renee (© ottam spre ctanaearam (© Assess the Diese ‘ean an 3a of the chest (© Perfo an echoeardography (© Octave: persion san (@) Adriouns al < ri0 > rereee eas type 2 dabetes melts ard bier ostsoarthits ofthe Ms Por to aan othe a espa nis mediatens wate meormin ad raptoce, Hs tebeatte 378 (1007 respatons fe 10min aa od pressure 106/70 es Hg UBER on room ar ahows an ongen saturation of BOR The long te claro sucutatin. cardiac sxamistion shone ne abnormates Theron owe eve esol. ght {oot feion nan upmard dracon cases pin inthe ight cal. Pedal pulses te palpi, Supplamerta oxygen and inivenous Mud resusctaton ae Segui hmaoerit i 30% tral blood sas nai om som a sho > peo: 37 mmHg Heoy 2a meq | slearoariogam shone smu events an rgnt cation. hen ae fling ee mee sppropnate na 2 Stepin te management of is patent? wh Fears of ght lower exert deep vin dombosis(e, tender olen Ie ith aon-arade fevered a psitve oman’ sgn He has als scare of 915 fr hear te > 10min, {estes of OVT, and for beng moe iy than another ghos ‘pulmonary emeoism (8, 2a < CF Solel og eee eee S Tr surgery the as 4 Wek, 3 Trcic ich nists a igh probabity of im hang a Comprension and color doppler utrasoragraphy generally wed fr dagnosingunetiyng DVT, which = presumably the ate Imam pater, However the pent scarey showing sgn of FE, and avant potently if-treaening nature of rss es, the ex bes step would be to conf the agnos's tough anche est. Dope uivasound ofthe lone “Thrombolysis with akeplase or other recombinant tisiue-type plasminogen activators (PA) f canidered im cases of massive PE iogns al < ria > “eo 9 a Comprension and color doppler utrasoragraphy generally wed fr dagnosingunetiyng DVT, which = presumably the ate Imam pater, However the pent scarey showing sgn of FE, and avant potently if-treaening nature of rss es, the ex bes step would be to conf the agnos's tough anche est. Dope uivasound ofthe lone Creme should be consdredo con he presence of «OV att statin an Weaurert of hs pants Thrombolys wth elie or ether recombinant tissue-type plasminogen achvators (Pi considered in cases of massive PE ‘hat eaures ight hea fare orn hemodyrameal arate peters eel BF 29m) egulngraurctaton, !iough his pa has «high probabity of PE and has ins of ight heat stan on EKG, hes heed tble, ‘nity tex shouldbe performed prior weatnar. Civen the padens ecerk othopede suger te igh emorhage ssc wh, hrmbols mould be conrad In his patient wth Wel seoe > ad hus ahigh pobabiy of hang a, en immediate spiral CT angiogram th onset chou be poformed va depth ulmanary seis ahd cafirm the hagas. Ti et ha oth igh zea {nd Speci for Pe, ana prods ime evidenceof pulmonary ati stucco nthe form of vised ing ere ore pulmonary ates. AdienalNadngs on spl CT may nce a wedge-shaped arc, when cles nays eats FECota ce‘low D-aimer nana pater wh low probaly of Wal cals <2) tay tls ou and mean hat ro fret Texting required. Tarlo paints in which shee ow suspicion of Fhe rs step should be wo obtain aO-dier el However, hs patent has mgh retest probabiny of PE tase pouen assessing O-cnets snot recommenced because thoy mayb elevated fra numberof ean. rcen surgery, smth pater, malanc, renal dsate pregnancy, or eps, van as ostve result. stead, mee speci tecmave ro lagose PEs nated ns een ‘Aitrouh aches radioragh soften exered when a patient admits tothe emergency department wth symotoms of espa sess not seniie nor Specie eteugh ois ou 1 Cai a daghoss oF FE Nonspeae Minas 08 ‘heat asograph tht my upges PE nce tlctan pleut! eum, cademegay Hamptons hump, 2 Westra Stan. The chest atearaph is usualy intially performed oul out her causes of spre, suchas preumena, fsumotorex, percards, or aor section, rs neve sad a3 conmaory tat fr pulmonary bola and ths fat Echorarogtephy swan detecting normale of he nght art het might ae for FE (eg. ight vanticule dation o”hyobness,Ratening or boning ofthe eaverncalar septum hat recuces et vera preteadlF may als be Usetunaetecng proximal es However, he main hmtaton of ecrocrdegapy alone ss poe Sesty For oe tira Ps Therefore emosiremeal sabe patents sale BP> 80 mm ig) im wheh PEs orang surpcted, another onfrmatry sets ecommended In hit patent, eenoatiotaphy ay be sed comncuon wth heeft 2 ‘examine gh heat hemedinaics,espeally ven the abnormal ih heat Mndngs on XG. ‘A veilaton-pefion (V/) sean showing area af rarmal verilation mined with persion fare suggests FE. loogh VQ Scans maybe used te degose Panther cagroste est that fase ard more ea aval has replaced a he best etre apres est m most mica! emer. Vi scans ake lng me saan atd que z muda medione technica to ptr he tent Asa resul VC cans re ened fr pets th severe real alcency who cannot, Tustaecainea a aaeiba Sak Cola Waa ahaa ened nae