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(820 year old athlete is involved in motorcycle erash. When he arrives in the ER. He shouts
that he cannot move his legs. On physical exam, there are no abnormalities of the chest,
abdomen, or pelvis. The patient has no sensation in his legs and cannot move them, but his
arms are moving. The patient's respiratory rate is 23, heart rate 88, and blood pressure is
80/60 mm Hg. He is pale and sweaty. What is most likely cause of his condition?
Neurogenic shock.
Cardiac temponade.
Myocardial contusion.
Hypothermia.
Abdominal hemorrhage.
{4.22 year old male presents following a motorcycle crash. He complains of the inability to
ove or feel his legs: His blood pressure is 80/50 mm Hg, heart rate is 70, respiratory rate is
418, GCS is 15. Oxygen is 99%on 2L nasal prongs. Chest X-ray, pelvic X-ray FAST are normal.
Extremities are normal. His management should be:
2L of IV crystalloid and two units of pRBSs.
2L of IV crystalioid, manitol and IV steroids.
‘unit of albumin and compression stockings.
\Vassopressors and laprotomy.
21 of crystalloid and vassopressors if BPdoes not respond.
Which of the following signs is least reliable for diagnosing esophageal intubation?
‘symmetrical chest wali movement.
End-tidal CO2
Bilateral breath sounds.
Oxygen saturation.
Chest X-ray demonstrating the ETT tip positioned above the carnia.
‘AG months old infant, being held in her mother's arms, is ejected on impact from a vehicle
that is struck head-on by an oncoming car travelling at 64 kph. The infant arrives in the ER
with multiple facial injuries, is lethargic, and in severe respiratory distress. Respiratory
ort is not effective using a bag mask device. And her oxygen saturation is falling.
supp%
are unsuccessful. The most appropriate
Repeated attempts at orotracheal intubation
procedure to perform next is:
‘Administer hellox and epinephrine.
Perform nasotracheal intubation.
Perform surgical cricothyriodotomy.
Repeat orotracheal intubation.
e. Perform needle. hyroidtor
latior beaten with @
atory rate is 22,
ould be
in fight, in which he was
Jes. Airway is clear, respi
\g. Which of the following *
28 year old male is brought to ER. He was involved i
wooden stick. His chest shows multiple severe br
heart rate is 126, and systolic blood pressure is 90 mm Hi
performed during the primary survey?
ges.
Tetanus toxoid administration.
Cervical spine X-ray.
Blood alcohol level
Rectal exam.
ries is addressed in the secondary survey?
Which one of the following inj
Forearm fracture.
Mid-thigh amputation.
Open fracture with bleeding.
Unstable pelvic fracture.
Bilateral femur fractures with obvious deformity.
Which one of the following statements is true regarding access in pediatric resuscitation?
nly be considered after five percutaneous attempts.
que.
nen percutaneous venous access
Intraosseous access should o1
Cut-down at the ankle is the preferred initial access techni
Internal jugular cannulation is the next preferred option w!
fail:
Intraosseouscannulation should be the first choice for access
Biood transfusion can be delivered through intraosseous access.
35 year old female sustains multiple injuries in a motor vehicle crash and is transported to
‘a small hospital in full spinal protection. She has a GCS of 4 and is being mechanically
ventilated. Intravenous access is established and warmed crystalloid Is infused. She remains
al and full spinal protection in maintained. Preparations are made to
hemodynamically norm:
to transport, which of
transfer her to another facility for definitive neurosurgical care, Prior
the following tests or treatments is mandatory?
FAST exam.
Chest X-ray.
Lateral cervical spine X-ray.
‘Administration of methiprednisolone.
CT of abdomen. 9
n is 98%. Chest
‘823 year old male is stabbed below the right nipple. He is alert, and his oxygen 620
tube was placed for treatment of hemopnueunthorax. BP 90/60 mm Hg after 1
solution. What is the next step in treatment?
a. Place a left-sided chest tube.
b. Re-examiy
©. Inscert central venous catheter.
d, Perform CT scan of the abdomen and pelvis.
©. Prepare for urgent throacotomy.
‘A22 year old male is assaulted in a bar. A semi-rigid cervical coller is applied, and he is
immobilized on a spine board, On initial exam, VS are normal, GCS is 15. Which of the
following is an indication for CT in this patient with possible minor traumatic brain injury?
Presence of hemotympanum.
Blood alcohol concentration of 0.16%.
Presence of an isolated 10 cm scalp laceration.
Presence of a mandibuler fracture,
History of assult.
. A 23 year old construction worker is brought to ER after falling more than 9 meters. VS: HR is
140, BP is 90/60, and RR is 36. He is complaining bitterly of lower abdominal and lower limb
ain, and his obvious deformity of both lower iegs with bilateral open tibial fractures. Which
of the following statements concerning the patient is true?
Pelvic injury can be ruied out based on the mechanism of injury.
Blood oss from the lower limbs is the most likely cause of hypotension.
X-ray of the chest and pelvis are important adjacent in his initial assessment.
Spinal cord injury is most likely cause of his hypotension.
Aortic injury is the most likely cause of his tachycardia.
. A 25 year old female in the third trimester of pregnancy is brought to ER following a high-
speed motor vehicle crash, She is conscious and immobilized on long spine board. RR is 24,
HR is 120, and BP is 70/50. Labs show a PaCO2 of 40 mm Hg. Which one of the following
statements concerning this patient is true?
a, Fetal assessment should take priority.
b. Log rolling the patient to the right will decompress the vena cava.
c. Rh-immunoglubulin therapy should be immediately administered,
d. The patient has likely impending respiratory failure,
e. Vasopressors should be given to the patient, 2B.
14,
15.
16.
v7.
hes very short of breath.
‘430 year old male is stabbed in the right chest. On arrival to ER,
HR is 120 and BP is 80/50 mma Hg. His neck veins are fat. There is no diminished ai entry O°
the right side, and there is dullness posteriorly on percussion. These findings are Ost
consistent with:
a. Tension pneumothorax.
b._ Pericardial tamponade.
. _Hypovolemia from liver injury.
4. Hemothorax
€. Spinal cord injury
{A specific aspect of the treatment of thermal injuries is
2. Chemical burns require the immediate removal of clothing
b. Patients who sustain thermal injury are at lower risk of hypothermia,
c. Patients with circumferential burns need prompt fasciotomies.
4. Electrical burns are associated with extensive skin necrosis (from entry point to ext)
fe. The Parkland formule should be used to determine adequacy of resuscitation.
‘A115 year old male is brought to ER after being involved in a motor vehicle crash. He is
unconscious and was intubated at the scene by EMS. On ER, 02's 92%, HR is 96 and BP is
150/85 mm Hg. Breath sounds are decreased on the left side of the thorax. The next step 15
2. Immediate needle cricothyroidoromy
b immediate needie thorecocentesi=
c. Chest tupe insertion.
d. Reassess the position of endotracheal tube
fe. Obtain a chest X-ray
Which one of the following statements is true?
a. Elevated ICP will not affect cerebral perfusion.
b. CSF cannot be displaced from the cranial vault.
< _ Cerebral blood fiow (CBF) is increased when the PaCO2 is below 30 mm He.
d. utoregulationCBF normally occurs between cert bral perfusion pressures of 50 to 150.
e. Hypotonic fluids should be used to limit brain edema in patients with severe head injury.
‘The first priority in the management of a long bone fracture is:
a. Reduction of the pain.
b. Prevention of infection in case of an open fracture.
c._ Prevention of further soft tissue injury.
d. Control of hemorrhage.
‘e. Improve long-term function. 18. 4.40 year old obese patient with GCS of 8 requires a CT. before transfer to CT you should:
3. Give more sedative drugs.
b. Insert a multilumen esophageal airway.
©. Insert a definitive airway.
d. Request a lateral cervical spine film.
©. Insert a nasogastric tube,
19. Lateral cervical spine films:
Must be performed in the primary survey,
Can exclude any significant spinal injury.
‘Should be combined with clinical exam, AP and odontoi
Are indicated in all trauma patients.
Require the following films: oblique views, AP, odontoid and fiexion-extension views
Prior to spinal clearance in trauma patients.
page
20. A 30 year old maie is brought to ER after falling 6 m. Fiail chest on the right, tachypneic anc
normal breath sounds. No hyperresonance or duliness. On oxygen by face mask. ABG are:
PaQ2 of 45, PaCO2 of 28 and pH of 7.47. Abnormalities in the patient's blood gases is due to:
Hypoventilation.
Hypovolemia.
Smali pneumothorax.
Pulmonary contusion
Fiail chest.
oe
21. An 82 year old male falls down five stairs and presents to the ER. All are true statements
jon compared to a younger patient with similar mechanism, except
regarding his cont
‘a. He is more likely to have had contracted circulatory volume prior to his injury:
b. His risk of cervical spine injury is increased due to degeneration, stenosis, and loss of
disk compressibility.
c. Intracranial hemorrhage will become sympotmatic more quickly.
d. His risk of occult fractures is increased.
e. His risk of bleeding may be increased.
22. The most specific test to evaluate for injuries of solid abdominal organs is:
a, Abdominal X-ray.
b. Abdominal U/S.
c. DPL
d. Frequent abdominal examination
e. CTof abdomen and pelvi jizedon a lon!
23, A.14 year old female is brought to ER after aling from a horse. She is immobolizedo 8
spine board with a hard collar and blocks, cervical spine X-rays
Will show cervical spine injury in more than 20% of these patients.
. Will exclude cervical spine injury if no abnormalities are found on the %-F2¥"
Are not needed if she is awake, alert neurologically normal, and has no neck pan.
midline tenderness.
4. Should be performed before addressing potential breathing or circulatory
e. May show atlanto-occipital dislocation if the power's ratio is <2
problems.
24. The most important consequences of inadequate organ perfusion Is:
Multiple organ failure.
Decreased base deficit.
b.
Acute gloumeruinephritis.
d. Increased ATP production.
e. Vasodilatation,
25, Hypertension foliowing 2 head injury:
Should be treated to reduce ICP.
‘May indicate imminent herniation from critically high ICP.
Indicates pre-existing hypertension.
Mandates prompt administration of mannitol.
Snould prompt burr hole drainage of potential subaural hematomas
26. Initial treatment of frostbite injuries involves:
Application of dry heat.
Rapid rewarming of the body part in circulating WARM water.
Debridement of hemorrhagic blisters.
Early amputation to prevent septic complications.
Massage of the affected area.
27. Signs and symptoms of airway compromise include all of the following except:
Change in voice.
Stridor.
Decreased pulse pressure.
Dyspnea and agitation.
Tachypnea.
peaooe arding a pregnant patient who presents
28. Which one of the following statements is true regs
following blunt trauma?
a. Early gastric decompressior ortant.
‘A hemoglobin level of 10 g/dl indicates recent blood loss.
The central venous pressure response to volume resuscitation IS blunted in pregnant
patients.
4. Alap belts the best form of restraint due to the sizeof the gravid utert
‘A PaCO2 of 40 mm Hg provides reassurance about the adequacy of respiratory function.
or vehicle crash. BP is 90/60 and HR
ion with a rise in her BP
29, A 30 year old is brought to ER after being injured in a mot
ases to 96/66. The
is 122. She responds to the rapid infusion of 1 liter of crystalloid solut
to 118/88 and a decrease in her HR to 90. Her BP then suddenly decre
least likely cause of her hemodynamic change is:
‘Traumatic brain injury.
Ongoing blood loss.
Biunt cardiac injury.
Inadequate resuscitation.
Tension pneumothorax.
ppege
30. Limb-threatening extremity injuries:
Require a tourniquet.
Are characterized by the pret
‘Should be definitively managed by application of a traction splint.
Are rarely present without an open wound.
Indicates a different order of priorities for the patient's initial assessment and
resuscitation.
ssence of ischemic or crushed tissue
Pao
after being involved in 2 motor vehicle crash. She is 30
‘ed with a lap and shoulder belt, and an airbag deployed.
best describes the risk of injury?
31, A29 year old female arrives in ER
weeks pregnant. She was restrain‘
Which one of the following statements
eases the risk of fetal loss.
with increased risk of maternal death.
the need for emergency C-section due to the risk of
The deployment of the airbag inc
The use of seatbelts is associated
The mechanism of injury suggests
impending abruption placenta.
fe risk of premature fetal delivery and death is red iced by the use of restraints.
fe, The deployment of the airbag increases the risk of maternal abdominal injury. 32.
33.
34.
35.
Supragiottic airway devices:
‘Are equivalent to endotracheal intubation.
Require neck extension for proper placement.
Are preferable to endotracheal intubation in a patient who cann
‘Are of value as part of a difficult or faile
Provide one form of definitive airway.
ot lie flat.
itubation pla!
peaose
after being struck by a car. On ER, GCS is 15, BP
on SL is 91%. Chest X-ray shows multiple rib
A70 year old male suffers blunt chest trauma
duction abnormalities. Management
is 145/90, HR is 72, RR is 24 and 02 saturation
fractures. ECG shows normal sinus rhythm with no con
should include:
Placement of a 22-french, right-sided chest tube.
Serial troponins and cardiac monitoring.
Thoracic splinting, taping, and immobilization.
Monitored IV analgesia
Bronchoscopy to exclude tracheobronchial injury.
panos
‘A125 year old maie presenting after a motorcycle crash. Initial exam reveais normal VS. There
isa large bruise over his epigastrium that extends to left flank. He has no other appearent
injuries. A CT of abdomen shows ruptured spleen surrounded by 8 large hematoma and fluis
in the pelvis. The next step in this patient's management Is:
Splenic artery immobilizatior
Pneumococcal vaccine.
Transfer to pediatrician.
Urgent laparotomy.
Surgical consultation
paoem
'A.30 year old male presents with a stab wound to the abdomen. BP is 85/60, HR is 130, RRis
25 and GCS is 14. Neck veins are flat, and chest exam is clear with bilateral breath sounds.
Optimal resuscitation should include:
Transfusion of fresh frozen plasma and platelets.
b. 500 mL of hypertonic saline and transfusion of pRBSS.
Resuscitation with crystalloid and pRBCs until base excess is normal.
preparation for laparotmy while initiating fluid resuscitation.
Fluid resuscitation and angioemobolization. 36.
37.
38.
39.
Initial resuscitation in adult trauma patients should:
liters
Use crystalloid to normalize BP.
Use permissive hypotension in patients with head injury:
Be with anon-blood colloid solution.
Be a minimum of 2 Lof crystalloid in all trauma patients prior t
altered level of
consciousness, opens his eyes on command, moans without forming discernible words, and
his patient is correct?
‘A.25 year old male is brought to ER following a bar fight. He has an
localizes to painful stimuli. Which one of the following concerning #
Mandatory intubation to protect his airway is required:
His GCS suggests a severe head injury.
His level of consciousness can be solely attributed to elevated blood alcohol.
Tis an important part of neurological exam.
Hyperoxia should be avoided.
Which one of the foliowing statements regarding genitourinary injuries is true
a, Urethral injuries are associated with pelvic fractures.
b. ‘the genitourinary tract.
{All patients with microscopic hematuria require evaluation of
Patients with gross hematuria and shock will have a major renal injury as the source of
hemorrhage.
intraperitoneal biadder injuries ere usualiv managed definitively with a urinary cat
Urinary catheters should be piaced in all patients with pelvic fractures during tne
primary survey.
Which one of the following physical findings does not suggest spinal cord injury as the cause
of hypotension?
a. Priapism.
b. Bradycardia.
c. Distended neck veins.
d. Diaphragmatic breathing.
‘Ability to fiex forearms but inability to extend them.
e
Cardiac temponade:
‘a. Isdefinitively managed by needle pericardiocentesis.
b. Is most common with blunt thoracic trauma and anterior rib fractures.
c. Is easily diagnosed by discovery of Beck's triad in the ER.
d._|sindicated by Kussmaul breathing.
e. Requires surgical intervention. First group ATLS questions.-
1- triage concept : save more lives with available resources
2- a patient with gun shot , BP 70/0 , Chest tube drained 120 mi , chest sounds normal. next step?
~ Laboratomy
3- persistent pneumothorax after placing chest tube. Diagnosis?
~ Tracheobronchial injury
4- which of the following is not part of the initial assessment?
- determining incomplete,or complete neurological deficit
5- echomosys in prenium , blood in mayatus ,what will you do?
- retrograde urethrogram
6- Class Il shock:
- normal BP
7- patient with minimal trauma to chest and tenderness ABCDE are good, how to manage?
- pain medication
&- old patient on B-blocker and Coumadin (warfarin), decreased BP, normal pulse, which of the following
is true?
- excessive fluids cause cardiopulmonary failure.
9- indication for intubation?
- maxilofacial injury
10- moderate head injury- GCS 11, what to do?
- CT scan+repeat GCS assessment
41-Neurogenic shock except: neurologic deficit
12- Neurogenic shock management: vassopressor
13- initial step in multiple injured pt: ask the patient's name
14- pt. with blunt trauma to abdomen. Decreased BP, no external bleeding: FAST i
daa aaa aaa ahaa“
PARANA
a
1
Which of the following is addressed in the secondary survey? Answer: Forearm fracture
2. Ayo
ay ung male fallen from height with obvious flail chest. ABG shows pH of 7.47. what is the cause of this
abnormality? Answer: pulmonary contusion
3. Cushing’
Cushing's triad which occurs in cases of increased intracranial pressure? Answer: Bradycardia with
‘regular respirations and isolated increase in SYSTOLIC BLOOD PRESSURE.
4. Trauma it
Trauma in pregnant women, clear fluid leakage from vagina is an indication for hospitalization.
5. blood at the external meatus > do RUG
6
Scenario of pelvic fracture, which statement is correct? Answer: vertical shear force with posterior
ligaments disruption.
7. 12 year old boy sustained blunt abdominal trauma while playing football. FAST scan is positive. He is
hemodynamically stable. What to do next? Answer: CT abdomen
&. Old patient, had multiple rib fractures, splinting of the right chest, what to do? Answer: give anali
$. Memorize indications for burn transfer ( eg> 10% surface area affected > transfer)
10. In comparison with young adults, elderly patients exhibit which of the foliowing regarding brain injuries?
A; increased cerebral blood fiow. B- less stretching of bridging veins C- less subdural hematomas D- less
brain contusions £- les mobility with angular acceleration and deceleration,
11. Which of the following will be missed by DPL? Answer: subcapsular hematoma of the spleen (because itis.
a retroperitoneal organ)
12. Which of the following tests will evaluate the retroperitonium? Answer: CT
13. Patient tried to commit suicide with a rope (hyperextension of the neck), when he presented to ER he had
hoarsness of voice and crepitation in the neck, what to do? A- needle cricothyroidotomy B- surgical
tracheostomy in OR C- direct laryngoscopy and intubation. Answer: 2???
14. Burn victim with signs of inhalation injury (carboneacous material, singed eyebrows) > Intubate.
15. Burn victim, has circumferential burn, core temperature is 34 C. what next? A- escharatomy B- rewarm C-
oxygen mask (I think the answer is C oxygen mask because you should follow the ABCD priorities)
16. Which of the followings is NORMAL in pregnancy? A-increased residual lung volume B- decreased plasma
volume C- decreased total RBC mass D- widened symphysis pubis. Answer is D
17. Trauma patient was hypotensive then you gave him 1 L of crystalloid and now he is alert and talking.
Which of the following statements is correct? He has good cerebral blood flow 18,
19,
20.
22.
23,
26.
27,
28.
29.
30.
31.
32.
—————————
Which of the followings is a contraindication for nasal intubation? A- depressed skull fracture B- Le Fort II
Fractures. Answer is B (Le Fort Ill fractures causes cribriform plate fracture)
Which of the followings will benefit from oropharyngeal airway? A- posterior displacement of tongue B-
laryngeal edema. Answer is A
Patient came with severe head injury GCS is 6 and has poor anal sphincter tone and diagrammatic
breathing. His hands are flexed across the chest. What is the cause of his injury? A-isolated head injury. B-
'umbosacral verterbral injury. C- Cervical vertebral injury. Answer is C
Question about widened mediastinum
Question about spinal board? Remove after completing assessment or it leads to decubetus ulcers
CSF is between? Arachinoid and pia matter.
- Question about transfer? Transfer after stabilizing the patient.
Scenario with scaip laceration .. the priority was to stop the bleeding with direct pressure. The other
choices are all after the circulation.
Patient with head injury and systemic hypotension, what is the most probable cause of his hypotension?
A- bleeding in the brain B- systemic hypovolemia. Answer is B
Dorsal column? Carries proprioception from the same side of the body.
Elderly fallen from horse... low blood pressure but normal heart rate...answer: current medications might
be involved.
Neurogenic shock. answer: unlikely if injury below the level of T6.
Which of the followings will NOT have an effect of the clinical presentation of hemorrhagic shock? A-
gender B- age extremes C- delay in transfer Answer:???
Patient with stab wound to the upper abdomen. Which test to do? A- abdominal X ray B- FAST C- barium
‘enema D- upper Gl endoscopy. Answer: B
Question about burn and fall from height. Answer: examine the pelvis and the long bones for fractures. ‘ ear i gti ne _ Examinaon A
‘ep prkng fot where he was shot te fer ane, pe 1s ANCOnSCHOUR
‘single buliet wound. He is breathing and aire a pa Tea
sand has no detectable blood pressure. Definitive management
a. form FAST
b. Trias inion of packed re blood cells
insert a nasogastric tube and urinary catheter sic initiating fluid therapy ~~
transter the patient to the operating room, while initiati oti
initiate fluid therapy to-retum his blood pressure to normotensh e
ins of the inability
A 22-year-vid male presents following a motorcycle crash. He’ ed 70. respiratory
‘omave oF fee! his legs. His bloodpressure is 80/50 mm Hg-heary rate is 10 -wesfitahkas
rateas 18, and Glasgow Coma Scale score is 15, Oxygen saturatio ae His,
| Prone. Chest-x-ray. peivic x-ray, and PAS are normal. Extremities are normal.
management should be>
&
a
©
2 Lof IV crystalloid and two units of pRBCs (packed red blood. celis) |
"2 Lof iV erystalloid, mannitol, and TV steroids re aene
J unit of albumin and compression stockings aaa
svasopressors and laparotomy
2 Loferystalloid and vasopressors if BP does not respond ~~
3. Which of the foliowing signs js least-reliable for diagnosing esophageal inuibation?
chest wall movement
tidal CO;
bilateral breath sounds
tion, ATS cation,
ad
fA 6-month-old infant, bei
. boing Wel infer mother’s arena, ehected-on spe HoH
“xahcte that is struck head-on by an onceining. ear teavelin at 4 kph {4 mph) “The
_jifant arrives in thezemergency department with multiple tac Anite, neta
Severe reepltatory dlistess. Respiratory support is nol effective usin» bag-mane
‘device. anther @xygen saturation is faling, Repeated ateents at eretractenl soatbatien
‘Are Unsuceeasful, The most appropriate procedure to perform tick is
sini
&audminister hetiox und racemic epinephrine
b.sperform nasotracheal intubation
perform surgical cricathyroidotomy
4. repeat orotrachea) intutsation
© perform needle crivothyroidotomy with jot invuffiation
‘A.28-year-old male's roughs to the emergency department, He was involved ana fight,
ae which he was beaten with a wooden stick, His chest shows voultipic severe brurses. His,
airway is clear, respiratory rate is 22 heart rate is 126.
men Hy. Which of the foliowing should be performed
Glasgow Goma Score. ~~
a
b. tetanus status
© cervical spine X-ray
d, blood atcohol level
ie
rectal exam
G—An 18-year old maic'is brought w your emergency depanmentatier being dumped by 2
‘Jamge wave while surfing. He landed head-firsi on the firm beach sand. His vial signs are:
blood pressure'$5/60 mm He. heart rate 60, and respwratory rate 18. He appears eal and
asks if he will ever walk again, ‘The most appropriate nexi step is to
92) teassure'the patient that ie will walk again
© proceed to.adetaited ncurotogical examination ~~ e
Sd. begin infusion of vasopressors
_€. begin wbolus-of warm intravenous crystalloid
‘tach one of the following statements is true regarding ace
ate an corny an 16 IP
ie es
. Aaa 8
‘mathmesi Ith aa ee pe
nn Shr cen hae rity univer
ance jews cw romance
“Prepumations
“Prior to tranaport, whieh a to following
PAST exan
-ehest xoray
Aateral cervical spline ¥-rH¥
“administration of methylprednisalone
-eomputerizes! tomography «Fue abstomen,
1A. 22-yoat-old male suai shorn wound the left shoulder anc chestast Come
-eauge. His blood yess ix ROMO-munit- Fi, wid his beara 136 beats per sina
ve eqpidy uatused, fis Hood prexnure #NeTEOs
tuchypnerc with
Tivo ters of erystalioid salubon an
ToT nnn Fig. wnt heart ents decreanes to 2100 beaks per mints: TS
| acrespicatare-rate-af 28 tyeaths por-animute. Cn physi preath sounds
-aroadcercascd! at the (elt upper chest with dalinesy an: perouaniuts
-Breneli) tbe tharacostoms inserted in the fifth intercostal space, with
Lnovair leak, The most apprapriate next step 1:10
jal exarminalion. 1
‘Alurge-cabiber (Ab-
return of200 mi
‘of Sood ant.
“a tneasure blood pressure agains
“begin 1 tanstinse O-nezative blood
“svat unit} the chest x-ray’ is completed
sean of the chest anc abdomen
ical oxamiinationol the chesive~ ‘
na emi cv eral. anes
i examination, his vital si ;
ore ae Hae cca uultnaissanieressaniemeenemeneillll
ATLS* aig
A 23-year-old construction worker is brought to the-emergency department after taliing
ee cet) from scaffolding. He 2s reported to have Janded ois Teet
eee ‘bear weight. His vitel signs are: heart rate 140, blood pressux:
am Hg, and respiratory rite 36- Me is complaining bitterly of lower abdominal ands
lower limb pain, and has obvious deformity ‘of both lower legs with bilateral open sibial
factires, Which one-of the following statements concersing this patient istewe?
Pelvic injury can be ruled out, based on the mechanism of iojury
a
B.__ Blood loss from the lower limbs is the most likely cause of his techyeardis,
<. _‘Krays of the patient's chest and pelvis are imnortant adjuncts im the initial,
‘assessment.
d, Spinal card injury is the most likely cause of his hypotension.
€ Aortic injury is unlikely
WZ, A 25-year-old female in the third trimester of pregnancy is brought to the emergency
| department following 2 high-speed motor vehicle erash. She 1sconscious and
3 immobilized ona long spinc board. Her respiratory rate 1s. 16, heart rate is 120, and ‘blood
pressure is 70/50. The laboratory results show 2 PaCO2 of 40-mm ‘Hg. Which one of the
following. statements concerning this patient is true?
~ Fetal assessment should take priority.
“Gog rolling the patient 1o the right will decompress the vens ce¥3,
“Rhsimmunoglobulin therapy: should be immediately administered.
“Phe patient has impending respiratory failure ~
“-Yasopressors should be given-to the patient,
id maic is stabbed in the n est. On-arrival in the emergency’ department,
short of breath. His heart rate is 120, and blood pressurcis $0/50.mm Hg. His
“On auscultation of the chest, there is Giminished ir entry ‘onthe tight
on percussion there is dullness posteriorly. ‘These Findings are: most-consistent
Pow
a
A
2 ATES Bdsm
M4. A specific aspect of the treatraemt of thermal injuries 1
remawvalof clothing ~~
igre a prelude to exion-extension views
ban re
othe hospital after falling 6 meters (20 feet) froma
1 reveals. an obvious flail chest on the right The
js sounds onthe right are slightly:
‘A 30-year-old male is brought
scaffold onto a pile of lumiber. Inspectior
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