A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his
blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute
and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for
decreased left chest breath sounds with the return of a small amount of blood and no air
leak. After chest tube insertion, the most appropriate next step is: - Correct Answer - re-
examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal
fractures. In the emergency department, he is alert, vital signs are normal, and he is
complaining of severe pain in both heels and his lower back. Lower extremity pulses are
strong and there is no other deformity. The suspected diagnosis is most likely to be
confirmed by: - Correct Answer - complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
Correct Answer - Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step
is to: - Correct Answer - secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2
liters. Which one of the following statements applies to this patient? - Correct Answer -
An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by: - Correct Answer - increasing
the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - Correct Answer
- urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: - Correct Answer - evidence of inadequate organ
perfusion
A 7-year-old boy is brought to the emergency department by his parents several
minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of
his medial right thigh. Immediate management of the wound should consist of: - Correct
Answer - direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - Correct Answer - cerebral vasoconstriction with diminished
perfusion
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