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ATLS 10
TH
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In comparison with young adults, elderly patients exhibit which of the following regarding brain injuries? A. Increased cerebral blood flow B. Less stretching of the bridging veins C. Less subdural hematomas D. Less brain contusions E. Less mobility with angular acceleration and deceleration D. Less brain contusions Which of the following will be missed by DPL? Subcapsular hematoma of the spleen (becauase it is a retroperitoneal organ) Burn victim, core temperature is 34C. Whats next? A. Escharotomy B. Rewarm C. Oxygen mask D... E.. C. Oxygen mask Which of the following is NORMAL in pregnancy? A. increased residual lung volume B. Decreased plasma volume C. Decreased total RBC mass D. Widened symphysis pubis E. D. Widened symphysis pubis
A 34-year-old man is brought to the ED after being pinned to the wall of building by a cement truck. He is in obvious shock, and has deformities and marked swelling of both thighs. Although no open wound are present, his shock: A. Cannot be explained without concomitant pelvic fracture B. Signifies a loss of approximately 15% C. Is consistent with blood loss from bilateral femoral fracture D. Will likely be reversed if appropriate traction splint are applied E. Cannot be explained by his observed injuries unless a major arterial injury exist C. Is consistent with blood loss from bilateral femoral fracture Prior to passage of urinary catheter in a man, it is essential to: A. Examine the abdomen B. Determine pelvic stability C. Examine the rectum and perineum D. Perform a retrograde urethrogram E. Know the history and mechanism of injury C. Examine the rectum and perineum The best guide for adequate fluid resuscitation of the burn patient is: A. Adequate urinary output B. Reversal of systemic acidosis C. Normalization of the heart rate D. A normal central venous pressure E. 4ml/kg/percent body burn/24 hours A. Adequate urinary output A 36-year-old woman is beaten about the head and face and is brought to the local community hospital in full spinal immobilization. Her BP is 13088, HR 70/minutes, and RR 18/minute. Pulse oximetry indicated 98% while she was given 100% O2 via a non rebreather mask. Her airway is clear. She has marked swellings on her face and several lacerations of her scalp that are not actively bleeding. She does not respond to verbal stimuli, but localizes to painful stiumuli and opens her eyes. She moves all extremities equally. The remainder of her physical exam is normal. There is no neurosurgeon at the local hospital. After ensuring the patient airway, the most appropriate course of action is to: A. Admit the patient to the hospital for observation B. Obtain x-ray of her facial bones prior to transfer C. Obtain complete x-ray evaluation of the cervical spine D. Transfer the patient to a neurosurgeon without performing a CT-sca D. Transfer the patient to a neurosurgeon without performing a CT-scan For the trauma patient with cerebral edema, hypercarbia should be avoided to prevent: A. metabolic acidosis B. Respiratory acidosis C. Cerebral vasodilatation
40mmHg, PaCo2 of 60mmHg and pH of 7,25. Appropriate immediate management at the time is to A. Ensure adequate tissue perfusion B. Increase the rate of fluid resuscitation C. Add PEEP D. Reassess for the presence of pneumothorax E. Administer IV narcotics in small amounts ?A. Ensure adequate tissue perfusion All of the following suggest urethral injury EXCEPT A. scrotal hematoma B. Blood in rectal lumen C. Blod in external urethral meatus D. High riding prostate on rectal exam E. Absence of a palpable prostate on rectal exam E. Absence of a palpable prostate on rectal exam Which one of the following is recommended method for threating frostbite? A. Moist heat B. Early amputation C. Padding and elevation D. Vasodilators and heparin E. Topical application of silversulphadiazine A. Moist heat A 32-year-old mans right leg is trapped beneath his overturned car for nearly two hours before he is extricated. On arrival in the ED, both lower extremities are cool, mottled, insensate and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessels and the muscles of the lower extremities are firm and hard. During the initial management of this patient, which of the followin is most likely to improve chances for limb salvage? A. Apply skeletal traction B. Administering anticoagulant drugs C. Administering trombolytic thearpy D. Performing lower extremity fasciotomies E. Immediately transfer the patient to a trauma care D. Performing lower extremity fasciotomies A 26 y/o seat belted driver is brought to the ED after a car crash. Primary survey reveals no evidence of serious injury except for diffuse, mild abdominal tenderness. Bowel sounds are hypoactive and liver dullness is questionable. Abdominal films reveal free air. The patient should A. Undergo peritoneal lavage B. Undergo promp celiotomy C. Have a contrast x-ray of her GI-tract D. Be carefully observed for further evidence of intraabdominal injury E. Be suspected of having a ruptured diaphragm and accompanying pneumothorax.
B. Undergo promp celiotomy The least likely cause of a depressed level of consiousness in the multisystem injured patient is: A. shock B. Head injury C. Hyperglycemia D. Impaired oxygenation E. Alcohol and other drugs C. Hyperglycemia Which one of the following statements concerning massive hemothorax is true? A. It is usually caused by blunt thoracic trauma B. It is commonly confused with pneumothorax C. The diagnosis should be confirmed by upright, plain chest x-ray prior to treatment D. The initial draining of 1000ml of blood after chest tube insertion requires immediate thoracotomy E. The condition should be suspected in situations with shock and unilateral absent breath sounds E. The condition should be suspected in situations with shock and unilateral absent breath sounds During primary and secondary survey, the patient injured by blunt trauma should be completely immobilized until A. The neurologic exam has been completed B. The patient is transferred to definitive care C. The patient is able to indicate that he has no neck pain D. A spinal fracture has been excluded by x-ray E. The patient complains of potential pressure sores due to the spine board. D. A spinal fracture has been excluded by x-ray Cervical spine injury A. Is excluded by a normal neurologic exam B. Is not present if the patient has normal range of motion C. Can be detected safely by careful flexion and extension of the neck D. Can be excluded by a crosstable lateral x-ray of the c-spine E. May be first manifested by neurologic deficit after movement of the neck E. May be first manifested by neurologic deficit after movement of the neck An 18 y/o man is brought to the ED after smashing his motorcycle into a tree. He is conscious and alert, but paralyzed in both legs and arms. His skin is pale and cold. He complains of thirst and difficulty in breathing. His airway is clear. His BP is 60/40 and his pulse is 140 bpm. Breath sounds are full and equal bilaterally. He should A. Undergo exploratory celiotomy B. Be treated for neurogenic shock C. Be treated for hypovolemic shock D. Undergo immediate nasotracheal intubation E. be placed in cervical traction tongs before any other treatment is instituted
B. Tilt head and lift chin C. Lift neck from behind D. Jaw thrust What is the approximate time the brain can be anoxic before developing irreversible damage? A. 10 min B. 5 min C. 2 min D. 20 min You are treating a truama patient and attempt a definitive airway by intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? A. Gum elastic bougie B. Lateral cervical spine x-ray C. Nasopharyngeal airway D. Oxygen E. Laryngeal mask airway A. Gum elastic bougie A 79 year old female is involved in a motor vehicle crash and presents to the ED. She is on Coumadin and a beta blocker. Which of the following statements is true concerning her management? A. The risk of subdural hemorrhage is decreased B. Absence of tachycardia indicates that the patient is hemodynamically normal C. Non-operative management of abdominal injuries is more likely to be successful in older adults than in younger patients D. Vigorous fluid resuscitation may be associated with cardiorespiratory failure D. epinephrine should be infused immediately for hypotension D. Vigorous fluid resuscitation may be associated with cardiorespiratory failure The most common acid base disturbance encountered in injured pediatric patients is caused by: A. Hemorrhage B. Changes in ventilation C. Renal failure D. Injudicious bicarbonate administration E. Insufficient sodium chloride administration B. Changes in ventilation? A 17 year old female is brought to the ED following a 2 meter fall onto concrete. She is unresponsive and found to have a RR of 32, BP 90/60 and HR 68. The first step in treatment is: A. Adminstering vasopressors B. Establishing IV access for drug-assisted intubation C. Seeking the cause of her decreased level of consciousness D. Applying oxygen and maintaining airway E. Excluding hemorrhage as a cause of shock
D. Applying oxygen and maintaining airway A 25 year old male is brought to the ED following a bar fight. He has altered consciousness, open his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? A. Hyperoxia should be avoided B. CT scanning is an important part of neurological assessment C. Mandatory intubation to protect his airway is required D. His GCS suggest severe head injury E. His level of consciousness can be solely attributed to elevated blood alcohol. B. CT scanning is an important part of neurological assessment Han har GCS på 10-11, således passer det ikke med svaralternativ D som tilsvarer GCS <9. Ettersom GCS er >8 passer heller ikke svaralternativ C. E er feil da det ikke kan gi så lav GCS Which one of the following statements regarding genitourinary injuries is true? A. Urethral injuries are associated with pelvic fractures B. All patients with microscopic hematuria require evaluation of genitourinary tract C. Patient presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage D. Intraperitoneal bladder injuries are usually managed definitively with a urinary catether E. Urinary catheters should be placed in all patients with pelvic fractures during the primary survey A. Urethral injuries are associated with pelvic fractures B er feil - det er pasienter med makroskopisk hematuri og/eller pas. med mikroskopisk hematuri og sjokk som det er aktuelt å gjøre CT av. C kan være riktig, men kan ikke si det sikkert at det er nyrene som er blødningskilden. D er feil - ekstraperitoneal blæreskade behandles med kateter, og E er feil da man først må undersøke for uretraskade Cardiac tamponade: A. Requires surgical intervention B. Is defintively managed by needle pericardiocentesis C. Is easily diagnosed by discovery of Becks triad in the ED D. Is indicated by Kussmaul breathing E. Is most common with blunt thoracic trauma and anterior rib fractures A. Requires surgical intervention A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is struck head on by an oncoming car traveling at 65kph. The infant arrives in the ED with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is: A. perform needle cricothyroidotomy with jet insufflation B. Administer heliox and racemic epinephrine C. Perform nasotracheal intubation
Which one of the following statement is true? A. Hypotonic fluids should be used to limit brain edema in patients with severe head injury B. Elevated intracranial pressure will not affect cerebral perfusion C. CSF cannot be displaced from cranial vault D. Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg E. Autoregulation of cerebral blood flow normally occurs between cerebral perfusion pressure of 50 to 150mmHg D. Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg A 40 year old obese patient with GCS of 8 requries a CT scan. Before transfer to the scanner, you should: A. give more sedative drugs B. Insert a defintive airway C. Insert a multilumen esophageal airway D. Request a lateral cervical spine film E. insert a nasogastric tube B. Insert a defintive airway A 30 year old male is brought toe the hospital after falling 6 meters. Inspection reveals an obvious flail chest on the right. The patient is tachypneic. Breath sounds are present and symmetrical. There is no significant hyperresonance or dullness. Arterial blood gas obtained while the patient recieves oxygen by face mask are: PaO2 of 45mmHg (6Kpa), PaCO2 of 28mmHg (3,7 Kpa) and pH of 7,47. The component of injury that most likely responsible for abnormalities in this patients blood gas is: A. Hypoventilation B. Pulmonary contusion C. Hypovolemia D. Small pneumothorax E. Flail chest B. Pulmonary contusion A 14 year old female is brought to the ED after falling from a horse. She is immobilized on a long spine board with a hard collar and blocks. Cervical spine x-ray: A. Will show cervical spine injury in more than 20% of these patients B. Will exclude cervical spine injury if no abnormalities are found on the x-rays C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness D. Should be performed before adressing potential breating or circulatory problems E. May show atlanto-occipital dislocation if the Powers ratio is <1 --> 1:noraml, >1 anterior, <1 posterior C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness The most specific test to evaluate for injuries of solid abdominal organ is: A. Abdominal x-ray B. Abdominal ultrasound C. DPL
D. Frequent abdominal examination C. CT of abdomen and pelvis C. CT of abdomen and pelvis The most important consequence of inadequate organ perfusion is: A. Vasodilatation B. Multiple organ failure C. Decreased base deficit D. Acute glomerulonephritis E. Increased cellular ATP production B. Multiple organ failure A 23 year old construction worker is brought toe the ED after falling more than 9 meters from scaffolding. He is complaining bitterly of lower abdominal and lower limb pain, and has obvious deformity of both lower legs with bilateral open tibial fractures. Which one of the following statement concerning this patient is true? A. Pelvic injury can be ruled out based on the mechanism of injury B. Blood loss from the lower limb is most likely cause of his hypotension C. Spinal cord injury is the most likely cause of his hypotension D. X-ray of the chest and pelvis are important adjuncts in his assessment E. Aortic injury is the most likely cause of his tachycardia. D. X-ray of the chest and pelvis are important adjuncts in his assessment A 82 year old male falls down five stairs and presents to the ED. All following statements are true statements regarding his condition compared to a younger patient with similar mechanism, except: A. He is more likely to have had a contracted circulatory volume prior to his injury B. His risk of cervical spine injury is increased due to degeneration, stenosis and loss of disk compressibility C. His risk of occult fractures is increased D. His risk of bleeding may be increased E. Intracranial hemorrhage will become symptomatic more quickly E. Intracranial hemorrhage will become symptomatic more quickly A 25 year old female in the third trimester of pregnancy is brought to the ED following a high speed motor vehicle crash. She is conscious and immobilized on a long spine board. Her RR is 24 bpm, HR is 120bpm, and BP is 70/50mmHg. The lab results show a PaCO2 of 40mmHg. Which one of the following statements concerning this patient is true? A. Fetal assessment should take priority B. Log-rolling the patient to the right will decompress the vena cava C. Rh-immunoglobulin therapy should be immediately administered D. Vasopressors should be given to the patient E. The patient has likely impending respiratory failure.
The first priory in management of a long bone fracture is: A. Reduction of pain B. Prevention of infection in case of an open fracture C. Prevention of further soft tissue injury D. Improve long term function E. Control of hemorrhage E. Control of hemorrhage A 30 year old female is brought to the ED after being injured in a motor vehicle crash. Her initialt BP is 90/60mmHg, and her HR is 122bpm. She responds to rapid infusion of 1L crystalloid solution with a rise in her BP to 118/88 and decrease in her HR to 90bpm. Her pressure suddenly decreased to 96/66. The least likely cause of her hemodynamic change is: A. Ongoing blood loss B. Blunt cardiac injury C. Traumatic brain injury D. Inadequate resuscitation. E. Tension pneumothorax C. Traumatic brain injury Limb-threatening extremity injuries: A. Require a torniquet B. Should be defintively managed by application of a traction split. C. Are rarely present without an open wound D. Are characterized by the presence of ischemic or crushed tissue. E. Indicate a different order or priorities for the patients initial assessment and resuscitation. B. Should be defintively managed by application of a traction split. A 29 year old female arrives in the ED after being involved in a motor vehicle crash. She is 30 weeks pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the following statement best decribes the risk of injury? A. Deployment of the airbag increased the risk of fetal loss B. The risk of premature fetal delivery and death is reduced by the use of restraints C. The use of seatbelts is associated with increased risk of maternal death. D. The mechanism of injury suggest the need for emergency ceasarean section due to the risk of impending abruptio placentae E. The deployment of the airbag increases the risk of maternal abdominal injury B. The risk of premature fetal delivery and death is reduced by the use of restraints Supraglottic airway devices: A. Are equivalent to endotracheal intubation B. Require neck extension for proper placement C. Are preferable to endotracheal intubation in a patient who cannot lie flat D. Are of value as part of a difficult or failed intubation plan E. Provide one form of definitive airway
D. Are of value as part of a difficult or failed intubation plan A 25 year old male is brought to the hospital after sustaining partial and full thickness burns involving 60% of his body surface area. His right arm and hand are severely burned. There are obvious full thickness burns of the entire right hand and a circumferential burn of the right arm. Pulses are absent at the right right wrist and are not detected by doppler examination. The first step in management of the right upper extremity should be: A. Fasciotomy B. Angiography C. Escharatomy D. Heparinization E. Tangential excision C. Escharatomy Hypertension following a headinjury: A. Should be treated to reduce intracranial pressure B: Indicates pre-existing hypertension C. May indicate imminent herniation from critically high intracranial pressure D. Mandates prompt administration of mannitol E. Should prompt burr hole drainage of potentialt subdural hematomas. C. May indicate imminent herniation from critically high intracranial pressure Initial treatment of frostbite injuries involves: A. application of dry heat B. Debridement of hemorrhagic blisters C. Early amputation to prevent septic complications D Rapid rewarming of the body part in circulation warm water E. Massage of the affected area D Rapid rewarming of the body part in circulation warm water Signs and symptoms of airway compromise include all of the following, EXCEPT: A. change in voice B. Stridor C. Tachypnea D. Dyspnea and agitation E. Decreased pulse pressure E. Decreased pulse pressure Which one of the following statements is true regarding a pregnant patient who presents following blunt trauma? A. Early gastric decompression is important B A Hb level of 10g/dl indicates recent blood loss C. The CVP response to volume resuscitation is blunted in pregant patients
Initial resuscitation in adult patient should: A. Be with 1-2L of crystalloid, monitorin the patients response B. Use crystalloid to normalize BP C. Use permissive hypotension in patients with head injury D. Be with a non blood colloid solution E. Be a minimum of 2L Crystalloid in all trauma patient prior to adminstering blood A. Be with 1-2L of crystalloid, monitoring the patients response Compared with adults, children have: A. A longer, wide, funnel shaped airway B. A less pliable, calcified skeleton C. Lower incidence of bony injury with neurogenic shock D. A relatively smaller head and larger jaw E. Anterior displacement of C5 and C B. A less pliable, calcified skeleton A 30 year old male presents after a motor vehicle crash. Vital signs are RR 18, HR 88, BP 130/72, GCS 13. Laparotomy is indicated when A. There is distinct seat belt sign over the abdomen B. The CT-scan demonstrates a grade 4 hepatic injury C. There is evidence of extraperitoneal bladder injury D. CT demonstrates retroperitoneal air E. The abdomen is distended with localized right upper quadrant tenderness. D. CT demonstrates retroperitoneal air Indikasjoner for laparotomi: Blunt abdominal trauma with hypotension, with a positive FAST or clinical evidence of intraperitoneal bleeding, or without another source of bleeding
- Hypotension with an abdominal wound that penetrates the anterior fascia
- Gunshot wounds that traverse the peritoneal cavity
- Evisceration
- Bleeding from the stomach, rectum, or genitourinary tract following penetrating trauma
- Peritonitis
- Free air, retroperitoneal air, or rupture of the hemidiaphragm
- Contrast-enhanced CT that demonstrates ruptured gastrointestinal tract, intraperitoneal bladder injury, renal pedicle injury, or severe visceral parenchymal injury after blunt or penetrating trauma A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed in the chest. There is 3cm wound just medial to the left nipple. His BP is 70/33 and HR is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminshed, iv access has been established and warm crystalloid is infusing. The next most important aspect of immediate management is: A. CT scan of the chest B. 12 lead ECG C. Left tube thoracostomy
D. Begin infusion of RBCs E. FAST exam E. FAST exam For å se etter tamponade? Normale resp.lyder bilateralt taler mot trykkpneumothorax. EKG vil ikke gi noe informasjon. Thoracostomy ikke indisert da det ikke er mistenkt pneumo/hemothorax. CT uaktuelt pga hemodynamisk ustabil A 47 year old house painter is brought to the hospital after falling 6 meters from a ladder and landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is blood in the external urethreal meatus. The initial diagnostic study for evaluation of the urinary tract in this patient should be: A. Cystoscopy B. Cystography C. IV pyelography D. CT scan E. Retrograde urethrography E. Retrograde urethrography Neurogenic shock has all of the following classic characteristics except which one: A. Hypotension B. Vasodilatation C. Bradycardia D. Neurologic deficit E. Narrowed pulse pressure E. Narrowed pulse pressure Which one of the following should be performed first in any patient whose injuries may include multiple closed extremity fractures? A. A thorough assessment of four limb perfusion B. Maneuvers to prevent necrosis of the skin C. Extremity compartment syndrome release D. Ensuring adequate oxygenation and ventilation E. Evaluation for occult crush syndrome D. Ensuring adequate oxygenation and ventilation Which of the following is the recommended Method for trestemt frostbite? A. Vasodilators B. Anticigulants C. Warm (40 degrees) water D. Padding and elevation E. Application of heat from a hairdryer C. Warm (40 degrees) water Which of the following physical findings suggest a cause of hypotension other than spinal cord injury? A. Prispism
B. Cutdown on the saphenous vein at the ankle C. Intraosseous catheter placement in the proximal tibia D. Percutaneous peripheral veins in the upper extremities E. Central venous access via the subclavian or internal jugular vein D. Percutaneous peripheral veins in the upper extremities A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to: A. Administer O-negative blood B. Apply external warming devices C. Control internal hemorrhage operatively D. Apply a pneumatic antishock garment (PASG) E. Infuse large volumes of intravenous crystalloid solutions. C. Control internal hemorrhage operatively Regarding shock in the child, which of the following is FALSE? A. Vital signs are age-related B. Children have greater physiologic reserves than do adults C. Tachycardia is the primary physiologic response to hypovolemia D. The absolute volume of blood loss required to produce shock is the same as in adults E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate D. The absolute volume of blood loss required to produce shock is the same as in adults A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his respirartory rate decreases to 36 breaths per minute and his blood pressure is 81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The next priority should be to: A. Perform external fixation of the pelvis B. Obtain abdominal and pelvic CT-scans C. Perform arterial embolization of the pelvic vessel D. Perform diagnostic peritoneal lavage or FAST E. Perform a urethrogram and cystogram D. Perform diagnostic peritoneal lavage or FAST A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty. Initially, his ventilations are easily assisted with a bag-mask device. It becomes more difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89%. The most appropriate next step is to: A. Obtain a chest x-ray
B. Decrease the tidal volume C. Decrease PEEP D. Increase the rate of assisted ventilations E. Perform needle decompression of the left chest. A. Obtain a chest x-ray (MÅ SJEKKES) A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve: A. Immediate angiography B. Tamponade of the wound with a pressure dressing C. Wound exploration and removal of bony fragments D. Realignment of the fracture segments with a traction splint E. Fasciotomy of all four compartments in the lower extremity B. Tamponade of the wound with a pressure dressing An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a crash. He had decreased level of consciousness at the scene, but then was alert and conversational during transportation. Now his GCS is only 11. Which of the following statements is TRUE? A. Cerebral perfusion is intact B. Intravascular volume status is normal C. The patient is in a postictal state D. Intra-abdominal visceral injury is unlikely E. The patient probably has an acute epidural hematoma E. The patient probably has an acute epidural hematoma A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two liters. Which one of the following statements apply to this patient? A. His pulse pressure will be widened B. His urinary output will be at the lower limits of normal C. He will have tachycardia, but no change in systolic blood pressure D. His systolic blood pressure will be decreased with a narrowed, pulse pressure E. His systolic blood pressure will be maintained with an elevated diastolic pressure. E. His systolic blood pressure will be maintained with an elevated diastolic pressure. The physioclogic hypervolemia of pregnancy has clinical significance in the management of the severely injured gravid woman by A. Reducing the need for blood transfusion B. Increasing the risk of pulmonary edema C. Complicating the management of closed head injury D. Increasing the volume of blood loss to produce shock/maternal hypotension E. Reducing the volume of crystalloid required for resuscitation
