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A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After 2 liters of crystalloid solution his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: a) reexamine the chest. b) perform an aortogram. c) obtain a CT scan of the chest. d) obtain arterial blood gas analyses - ANSWER>>a) reexamine the chest Which one of the following physical findings suggests a cause of hypotension other than spinal cord injury? a) priapism. b) bradycardia. c) diaphragmatic breathing. d) presence of deep tendon reflexes. - ANSWER>>d) presence of deep tendon reflexes. A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: a) compartment pressures b) retrograde urethrogram c) Doppler-ultrasound studies d) complete spine x-ray series - ANSWER>>d) complete spine x-ray series In managing the head-injured patient, the most important initial step is to: a) obtain c-spine film.
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