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c. bilateral breath sounds ' d . oxygen -.aturation >92°/o c. L I I abo' e carina on chest x -ra\• e WI · h ·· · · in sc'-erc trauma !c one of the folio'' ing signs necessitates a ddimU'-e mrwa) 1 pat•cnts'! a · facial lacerations c h. repeated vomiting c. sc\crc maxillofacial fractures u. ~tcrnal fracture c. HIJ)\

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A narrowed pulse pressure is not seen in neurogenic shock. http://www.surgeons.org.uk/advanced-traumalife-support/shock.html

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Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliantFull-thickness circumferential and nearcircumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue deat . http://emedicine.medscape.com/article/80583-overview

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\ ~0-) cdr-old \\oman tell down four stairs landing on c,,n..~rt'tl~. ~.·.itt~""' \\ttuhc appcurs til be fu nctioning nnd in good position. He remains hcmody nomicnlly normal with no 'i~tn ~ of rc.,piratory distress. The most likely cause fo r his pcrsi... t~·nt 1 i~ht pncumothurux is:

n. nail chest b. diaphmgmnric injury

• c. pulmonary conlw;ron d. esophageal pcrforo1ion c. tracheobronchial injur

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A 22-year-old female who is 6 m~mths prc~nant presents following a motor vehicle crash. Paramedics reJX•rt vaginal hlccdlng. What is the initial step in her treatment?

a. assess fetal heart sounds

b. check for fetal movement c. pcrfonn inspection of the cerv~x d. ask the patient what her name 1s . . e. insert a wedge under the patient's r1ght h1p

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A constru · dcparune~uon_ worker falls from a . o f lo\.\er a~~~s.hean rate is 124 an~~~ and~ ~sfe:1ed to the coeT:>tXXY spine and . . ~mal pa in. After a . pressure b g, 60 mm H:. He ax:-;..azc. . .s~smg the air\.\ a) and chest. ~r · _.,.__ · Initiating nu·d I re susc Jtauon the . IZm:c '"""" c n. FAS-... · next step tS to perform: ' I

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d . cervical spine x-ray e . urethral catheterization

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A 2 2 -year-old male s usta' range. His blood press 1 ~ 5 ; :.~otgun " ound to the left shoulder and cr:.es:. ;nc\cse After 2 liters ofcrysta~:~s ~ ~0 mm Hg. and his heart rate is 130 beazs ~c~'2 to 122/84 mm Hg and h I so uudo n are rapidly infused. his blood pres-w;e . · h a respLratory . • rate o eartrate ec reases.to 100 beats per mm\Jl.C. \.\It f 28 b He i5 uC::.: ,x-e,c sounds are decreas d h reaths per mmute. On pb)sical exam.in3tic"L .:S bee!::' caliber (36 F h}e at l e left upper chest ,, jth d ullness on percussion. ,\ 1.:!--- rene tube tho racosto · · lttd · • :the retu rn of200 mL o f bl oo d and no mya1r leak. mse Themmost the fifth intercosul sp:ore -cw: appropriate oe:n step~

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msert a Foley catheter begin to transfuse 0-negative blood perform thoracotomy obtain aCT scan of the chest and abdomen repeat the physical examination of the chest

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Which one of the following statements concerning spine and spina'. cord {I'a'Ol'tl3 \5

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A normal lateral c-spine film excludes injut') . b. A vertebral injury is unlikely in the absence ofph)sica\ fmdingsofarord c. A patient with a suspected spine injW') requires immob\\iz.:nion on a -hort sp\ne a.

board. d. Diaphragmatic breathing in an unconscious patient" ho has fulkn is a sign ot .:injury. of whether a spinal cord lesion is complete or incomplete must be e. spine Detennination made in the primar) sur. e}. d

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The laryngeal mask airway (LMA) is a supraglottic airway device

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pseudosubluxation" at C2/C3 - a posterior step may be seen, Neurogenic shock can result from severe central nervous system damage

a . a longer. wider. funnei-'Shapel . h. a less pliable:. calcified sketC:U:..r i3Y c. lo"'er incidence of borl - • • d. relath el) smaller h~ ~rr.._ ;itt: _neur...gen~e sflcck e. ante · d' .....'!tt Ja';\i Children have a higher incidence of complete rtor rsplacemcnt of C5 on C6 spinal cord injury without radiographic abnormalit

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A ma1c present'> fiollowing a motor ~lucie cosh • re .30-)car-old . s p rratol) rate 18. hcan r.rte 88 blood ~ .:a S ·ale 13 • pressur-BOJ - mm g; :rnd.... \; !>Core · Laparotom!' is indicated r.en~ .....,,..,.

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there is a distinct seat belt si~ over tne acdomer. the sc~n demonst.-ates a ~race A L-.~ic n1ucy the re rs e\rdence of an extraperitoneal.;.;;dder ir.'ur CT demonstrates retroperitoneal air • the abdomen is distended v.ith locali:wf r:ght uppc:' cwa&--...nt•l=:11.dt;ne :il~·~~~ stabbed in the chest. There is a 3-C 111 \Itt"" huulll he \On idtrcd I'•

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11lol h IIIIth:' lull~ llt~\\n n lltuht ul tnirJI. She has extensive bruisinS of her " d 'to~ "' tuhllh 11.1 I II 1 lt~:tul till~ " 1211, hluud prcs~urr: is 'J()/70 mm II g. an rcspll'll • tnh' •~ 'II Ill("'''"'"''" '"lllllllltttl~ llllt\lu:.uhly explained by: 11

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\ .!.!•\l'·" ,,1,1 ''''""'" fall~ 1\hilc skiing. She prcsenb on a spine board "" : · c~n ica\ ~ oll.u: ,,,~ c''" m.1~k ,tt S I • und t\\o antecubital IVs. Iler Glasgo\\ Coma "~a.c ,core is 12. pupils ,trl' t'qtrnl, hlnod pres\ltre is 135176 mm Hg. hcan rate b 1 O'> ,md rl'spi ,11111 > Ill It' is I1), < hcst \• r!IY is normal. 1 his patient's management priorilic~ are: 1 ll

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39.

A ~oung male patient is brought to the emergency dcp3nment followin~& 5-met.:r (16-foot) fall from a roof. He responds to pain b) pushing nwoy your hand, op;;nlll~ his eyes, and verbalizing inappropriate words. Pupils ore equal . The m~l hnporhtnl s tep in management of this patient would be:

a. immediate intubation to protect his airway b. c. d. e. 40.

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administer 25 mglkg IV bolus mannitol insert nvo large-bore IVs alcohol and drug screening . detennine w hether amnesia is present and. if so, for what period ofume

ln a patient with a spinal cord injury, sacral sparing: a. refers to a fracture of the sacrum b . is part of the spinal shock syndrome c. is a good prognostic sign d. is diagnostic of a Power's ratio < I . d e . occurs only with complete transection of the lumbosaccal sp•nal cor

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