You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mm Hg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor.Which of the following treatment regimens would be the most appropriate for this patient?
Answer(s): A
Treatment of a gunshot wound to the thorax would include taking necessary spinal precautions. The open wound should be covered with an occlusive dressing. The respiratory distress should be treated with high flow oxygen with consideration of positive pressure ventilation and possible intubation. In addition, an IV should be started for a fluid route if hypotension worsens. Rapid transport is indicated for pericardiocentesis and possible surgery.
You are treating a 12-year-old male patient who was hit in the nose with a baseball. His nose is deviated to the left with moderate epistaxis. He is complaining of severe pain to his nose. He is alert and oriented with no loss of consciousness. Which of the following treatment sequence would best manage this patient?
Answer(s): D
Holding pressure on the nares is the proper technique to control epistaxis while leaning the patient forward to prevent blood from draining down the throat. Leaning the patient forward should not be performed if spinal precautions are necessary.
You are called for an elderly female that fell down and hurt her knee. When you find the patient, she tells you she tripped and fell, and landed on her left knee. She denies any loss of consciousness or trauma to her head. The patient is only complaining of pain to the distal portion of her femur. During your assessment, you notice deformity and swelling to the femur, proximal to the knee. The patient has good distal pulses, motor function, and sensation. What would be the most appropriate treatment for this patient?
The patient with a femur fracture should be secured to a backboard and padded appropriately. Inflating both leg sections of the PASG is not indicated for this patient. Secure femur while helping to tamponade any blood loss. Traction splinting is only appropriate if the femur fracture is mid shaft. Padded board splints will not provide sufficient stabilization.
Which of the following patients would be most appropriate for triage to a non-trauma center?
Answer(s): C
Of the 4 choices, the patient with a laceration on her thigh has an isolated injury and can be effectively managed by a non-trauma center. The other 3 patients require a more thorough assessment and therefore should be evaluated at a trauma center.
You have responded to a local residence of a 37-year-old male who had lacerated his leg while using a chainsaw in the back of his house. Prior to your arrival, the patient’s wife, who is a nurse, applied pressure to the wound and has the patient in Trendelenburg position. Your assessment of the patient reveals him to be responsive to painful stimuli with a weak carotid pulse and the blood pressure unobtainable. There is a massive amount of blood surrounding the patient on the ground. The wife tells you that the wound is arterial and the injury occurred about 10 to 15 minutes ago. In addition to oxygen therapy, what are your treatment priorities for this patient?
Direct pressure and fluids are this patient’s best chance for survival and prevention of decompensated shock. ALS should be activated to administer fluids as soon as possible.
Which of the following is an early, and the most prominent, finding in a crush injury?
Pain is generally the most obvious sign of a crush injury and tends to present earliest out of all of the other associated signs and symptoms.
Your 26-year-old female patient has been pulled out of a house fire. Her chest and arms have been burned. The area is charred and the patient states she has little pain in the burned area. What is the most likely classification of this patient’s burns?
The patient is most likely experiencing a full thickness burn with disruption of the soft tissue through the nerve root. They are typically painless, with the exception of the penumbra, because of the lack of nerve stimulation.
You have responded for a 43-year-old male who was involved in an altercation. The patient was reportedly beaten about the face and head with a baseball bat. The patient is unresponsive. Evaluation of the patient’s face reveals instability from the orbits to the mandible. Based on this information, how would you definitively manage this patient’s airway?
Answer(s): B
This patient has an unstable face and an unstable airway. Ultimately, this patient needs to have his airway protected as quickly as possible with an endotracheal tube. With facial instability, it is imperative that an adjunct be placed to ensure that the airway is not occluded by the pressure on the jaw created with the application of the bag-valve-mask.
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