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  y tube i POST TEST ONLINE1. An 8-year-old girl is an unrestrained passenger in a vehicle struckfrom behind. In the emergency department, her blood pressure is80/60 mm g, heart rate is 80 beats per minute, and respiratoryrate is !6 breaths per minute. er #$ score is !%. $hecomplains that her legs feel &funny and 'on(t move right)&ho'ever, her spine *-rays do not sho' a fracture or dislocation. Aspinal cord in+ury in this childa. is most likely a central cord syndrome.b. must be diagnosed by magnetic resonance imaging.c. can be e*cluded by obtaining a # of the entire spine.d. may e*ist in the absence of ob+ective ndings on *-ray studies.e. is unlikely because of the incomplete calcication of the vertebral bodies. 2. egarding shock in the child, 'hich of the follo'ing is A$12a.3ital signs are age-related.b.#hildren have greater physiologic reserves than do adults.c.achycardia is the primary physiologic response to hypovolemia.d.he absolute volume of blood loss re4uired to produce shock is the same as in adults.e.An initial 5uid bolus for resuscitation should appro*imate 0 m/kg of inger(s lactate. 3. A young man sustains a gunshot 'ound to the abdomen and isbrought promptly to the emergency department by prehospitalpersonnel. is skin is cool and diaphoretic, and he is confused.is pulse is thready and his femoral pulse is only 'eaklypalpable. he defmitive treatment in managing this patient is toa.administer 0-negative bloodb.apply e*temal 'arming devicesc.control intemal hemorrhage operatively.d.apply the pneumatic antishock garment.e.infuse large volumes of intravenous crystalloid solution. 4. An electrician is electrocuted by a do'ned po'er line after a thunderstorm. e apparently made contact 'ith the 'ire at the level of the right mid thigh. In the emergency department, his vital signs are normal and no dysrhythmia is noted on 1# . 7n  e*amination, there is an e*it 'ound on the bottom of the right foot. is urine is positive for blood by dip stick but no #s are seen microscopically. Initial management should includea.immediate angiography.b.aggressive 5uid infusion.c. intravenous pyleography.d.debridement of necrotic muscle.e.admission to the intensive care unit for observation. 5. A teen-aged bicycle rider is hit by a truck traveling at a high rateof speed. In the emergency department, she is actively bleedingfrom open fractures of her legs, and has abrasions on her chestand abdominal 'all. er blood pressure is 80/90 mm g, heartrate is !%0 beats per minute, respiratory rate is 8 breaths perminute, and #$ score is 6. he rst step in managing thispatient is toa.obtain a lateral cervical spine *-ray.b.insert a central venous pressure line.c.administer  liters of crystalloid solution.d.perform endotracheal intubation and ventilation.e. apply the :A$ and in5ate the leg compartments .6. A 9-year-old boy is struck by an automobile and brought to theemergency department. e is lethargic, but 'ithdra'spurposefully from painful stimuli. is blood pressure is ;0 mm gsystolic, heart rate is !%0 beats per minute, and his respiratoryrate is <6 breaths per minute. he preferred route of venousaccess in this patient isa.percutaneous femoral vein cannulationb. cutdo'n on the saphenous vein at the ankle.c.intraosseous catheter placement in the pro*imal tibia.d.percutaneous peripheral veins in the upper e*tremities.e.central venous access via the subclavian or interna!  +ugular vein. 7. =hich one of the follo'ing statements is A$1 concerning hisoimmuni>ation in the pregnant trauma patient2a.It occurs in blunt or penetrating abdominal trauma.b.?inor degrees of fetomaternal hemorrhage produce it.c.A negative @leihauer-etke test e*cludes h isoimmuni>ation.d.his is not a problem in the traumati>ed h-positive pregnant patient.e.Initiation of h immunoglobulin therapy does not re4uire  proof of fetomaternal hemorrhage. 8. Absence of breath sounds and dullness to percussion over theleft hemithora* are ndings best e*plained bya.left hemothora*.b.cardiac contusion.c.left simple pneumothora*.d.left diaphragmatic rupture.e.right tension pneumothora*. 9. A <-year-old man is brought immediately to the emergencydepartment from the hospital( s parking lot 'here he 'as shot inthe lo'er abdomen. 1*amination reveals a single bullet 'ound.e is breathing and has a thready pulse. o'ever, he isunconscious and has no detectable blood pressure. 7ptimalimmedi(ate management is toa.perform diagnostic peritoneal lavage.b.initiate infusion of packed red blood cells.c.insert a nasogastric tube and urinary catheter.d.transfer the patient to the operating room, 'hile initiating 5uid therapy.e.initiate 5uid therapy to return his blood pressure to normotensive 10. A young 'oman sustains a severe head in+ury as the result of a motor vehicular crash. In the emergency department, her #$score is 6. er blood pressure is !%0/;0 mm g and her heartrate is 80 beats per minute. $he is intubated and is beingmechanically ventilated. er pupils are < mm in si>e and e4uallyreactive to light. here is no other apparent in+ury. he mostimportant principle to follo' in the early management of herhead in+ury is toa.administer an osmotic diuretic.b.prevent secondary brain in+ury.c.aggressively treat systemic hypertension.d.reduce metabolic re4uirements of the brain.e.distinguish bet'een intracranial hematoma and cerebral edema. 11. All of the follo'ing signs on the chest *-ray of a blunt in+uryvictim may suggest aortic rupture 1#1:Ba.mediastinal emphysema.b.presence of a &pleural cap.&  c.obliteration of the aortic knob.d.deviation of the trachea to the right.e.depression of the left mainstem bronchus 12.  'enty-seven patients are seriously in+ured in an aircraft accident at a local airport. he basic principle of triage should be toa.treat the most severely in+ured patients rst.b.establish a eld triage area directed by a doctor.c.rapidly transport all patients to the nearest appropriate hospital.d.treat the greatest number of patients in the shortest periodof time.e.produce the greatest number of survivors based on available resources. 13.  he primary indication for transferring a patient to a higher level trauma center isa.unavailability of a surgeon or operating room staC.b.multiple system in+uries, including severe head in+ury.c.resource limitations as determined by the transferring doctor.d.resource limitations as determined by the hospital administration.e.'idened mediastinum on chest *-ray follo'ing blunt thoracic trauma. 14. Immediate chest tube insertion is indicated for 'hich of the follo'ing conditions2a.:neumothora*b.:neumomediastinumc.?assive hemothora*d.Diaphragmatic rupturee.$ubcutaneous emphysema 15. During resuscitation, 'hich one of the follo'ing is the most reliable as a guide to volume replacement2a.:ulse rateb.ematocritc.lood pressured.Erinary output

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Jul 23, 2017

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Jul 23, 2017
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