A 23-year old male driver involved in a head-on motor vehicle collision is brought to the ER. On initial evaluation in the trauma unit, his blood pressure is 180/70 and his pulse is 56. After initial evaluation and resuscitation you obtain a CT scan of his headThe patient in the above scenario is then transported to the ICU. The most appropriate initial evaluation and management would include which of the following?
Answer(s): C
The management of elevated intracranial pressure following traumatic injury has been extensively studied. Several interventions have been shown to be of benefit in the acute setting. The pressure can be relieved through mechanical means such as elevating the head of the bed to 30 degrees or by direct drainage of cerebrospinal fluid via a ventricular catheter. Administration of a hyperosmotic solution such as mannitol can decrease intracranial pressure by reducing brain water, increasing plasma volume and reducing blood viscosity. Additionally, if the ICP is refractory to these interventions, it is reasonable to consider a barbiturate coma or potentially a decompressive craniectomy. Hyperventilation is used only in the acute setting to keep PaCO2 around 35 mmHg, which functions to decrease intracranial pressure by decreasing intracranial blood volume through vasoconstriction. MRI would not be indicated initially, as it would not change your management. Severe head injuries are a frequent problem encountered in the field of trauma. CT scans are the primary diagnostic modality used to evaluate patients with suspected head injuries. Elevated intracranial pressure is a frequent result of severe brain injury either from brain swelling or mass effect from expanding hematomas. Subdural hemorrhages typically have a crescent shape and extend across suture lines covering the entire surface of one hemisphere. These are usually the result of the disruption of bridging veins. Epidural hematomas on the other hand have a biconvex lens appearance on CT scan. They typically develop afteran injury to the middle meningeal artery. Brain injury is generally greater in patients with subdural hematomas than in those with epidural hematomas.
A 23-year old male driver involved in a head-on motor vehicle collision is brought to the ER. On initial evaluation in the trauma unit, his blood pressure is 180/70 and his pulse is 56. After initial evaluation and resuscitation you obtain a CT scan of his headThe finding on the imaging study is most commonly associated with injury to which of the following?
Answer(s): B
A 49-year-old male underwent his last chemotherapy session for testicular cancer 3 weeks ago and now is complaining of shortness of breath. Which of the following drugs is most probably causing his problems?
Answer(s): D
Bleomycin is known to cause pulmonary fibrosis. Doxorubicin toxicity is predominantly manifested by leucopenia and cardiotoxicity. Etoposide is a podophyllotoxin derivative that inhibits topoisomerase which normally unwinds DNA and is associated with myelosuppression. Cisplatin is a platinum alkylating agent that can be nephrotoxic and ototoxic. Vincristine is a microtubule inhibitor that can result in peripheral neuropathy.
A25-year-old African American female develops a large lesion on her ear lobe after having it pierced (see Figure). How would you advise this patient?
Keloids occur at the site of injury, predominately in people with dark skin who have a genetic predisposition. The keloid is a form of benign tumor that consists of an overabundance of collagen that extends beyond the margins of the incision. Treatment options have only moderate success and include excision of the keloid with intralesional steroid injections. Recurrences of keloids, both at the original site and with subsequent injury/incision elsewhere in the body, are common. They are not associated with decreased fertility or other systemic processes
A 24-year-old male is involved in a house fire. His sputum is carbonaceous and he has suffered second- and third-degree burns to 65% of his total body surface area (TBSA). He is intubated in the ED without difficulty. A capnometer is placed at the end of the endotracheal tube and there is positive change in color. Examination of his chest reveals bilateral equal breath sounds. Suddenly he experiences ECG changes and goes into cardiac arrest. Which of the following drugs is most likely to be responsible for this event?
Succinylcholine is a depolarizing neuromuscular blocking agent that can cause arrhythmias including bradycardia and junctional rhythms because of vasotonic effects. Additionally, succinylcholine is associated with a transient hyperkalemia that can be profound in patients with burns or those who have experienced significant crush injury and result in cardiac arrest.
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