Trauma Management: Identifying and Addressing Critical Injuries, Exams of Nursing

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ATLS Pretest + Modules

re-examine the chest 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 initial fluid resuscitation 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. A tube thoracostomy is performed for decreased left chest 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: complete spine x-ray series 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: Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation. Which of the following is true regarding the initial resuscitation of a trauma patient? secure the airway In managing a patient with a severe traumatic brain injury, the most important initial step is to: An ABG would demonstrate a base deficit between -6 and -10 mEq/L. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? increasing the volume of blood loss to produce maternal hypotension The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: urinary output of 0.5 mL/kg/hr The best assessment of fluid resuscitation of the adult burn patient is:

evidence of inadequate organ perfusion The diagnosis of shock must include: direct pressure on the wound A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: cerebral vasoconstriction with diminished perfusion For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: perform an exploratory laparotomy After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: Leakage of amniotic fluid is an indication for hospital admission. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? administer supplemental oxygen The first maneuver to improve oxygenation after chest injury is: 9 A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: perform needle or finger decompression of the right chest A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: respiratory rate of 40 breaths per minute

Which one of the following findings in an adult is most likely to require immediate management during the primary survey? placement of an occlusive dressing over the wound The most important, immediate step in the management of an open pneumothorax is: history of neurological reaction or severe hypersensitivity to the product The following are contraindications for tetanus toxoid administration: breath sounds A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? The trachea is relatively short. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: urgently transfer the patient to the operating room A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: restrict cervical motion and attempt orotracheal intubation using 2 people A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE?

moist heat Which one of the following is the most effective method for initially treating frostbite? surgical consultation for right lower extremity fasciotomy A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? suction the oropharynx A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: repeat the primary survey and proceed with transfer A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: call the receiving hospital and speak to the surgeon on call A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: tachycardia Hemorrhage of 20% of the patient's blood volume is associated usually with: Aspiration of bone marrow confirms appropriate positioning of the needle.

Which one of the following statements concerning intraosseous infusion is TRUE? avoid hypotension A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: cardiac tamponade A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is

15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: development of peritonitis on physical exam A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? Log rolling using 4 people is a safe approach to restrict spinal motion when moving her. A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? restrict cervical motion and establish a definitive airway A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: The head is proportionally larger in infants than in adults. When applying the Rule of Nines to infants: placement of a pelvic binder A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is:

positive pregnancy test, Rh negative, and has torso trauma Which one of the following situations requires Rh immunoglobulin administration to an injured woman? prepare for an exploratory thoracotomy A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is: A pulmonary contusion may be present in the absence of rib fractures. A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? D C D C B A D - RSI is indicated in patients who need airway control, but have intact gag reflexes; indicated esp in patients who have sustained head injuries. A D D C D D C

-A FAST exam will evaluate the abdomen, but not the chest cavity... C Radiographic signs of blunt aortic injury include: -Widened mediastinum -Obliteration of the aortic knob -Deviation of trachea to the right -Depression of the left mainstem bronchus -Elevation of the right mainstem bronchus -Obliteration of aortopulmonary window -Deviation of esophagus/nasogastric tube -Widened paratracheal stripe -Widened paraspinal interfaces -Presence of a pleural or apical cap, left hemothorax, fractures C C C A D A D C C C

D D D B A B C D B A C A B A D

-the major cause of mortality in the geriatric population after rib fracture is the development of pneumonia. -the aging process causes a decrease in functional residual capacity, decrease in compliance of the lung and chest wall, and decreased mucus clearance form the airways B C C D

-Findings suggestive of ecclampsia are: 1 - proteinuria 2 - peripheral edema 3 - hyperreflexia B B -Fibrinogen levels are mildly elevated later in pregnancy A B C -With a hypotensive patient and a positive FAST, an exploratory laparotomy is mandatory in order to control bleeding and correct hypotension, as this will worsen neurologic outcome if not corrected. A -patient with deteriorating neurologic status requires transfer, as he or she is likely to require intervention in the form of invasive neurologic monitoring or craniotomy. -patient with burns >20% TBSA should be transferred.

B

Airway Breathing Circulation Situation Background Assessment Recommendation Re-examine the chest Complete spine x-ray series Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation Secure the airway An ABG would demonstrate a base deficit between -6 and -10 mEq/L. It increases the volume of blood loss to produce maternal hypotension. Urinary output of 0.5 mL/kg/hr Evidence of inadequate organ perfusion

Direct pressure on the wound Cerebral vasoconstriction with diminished perfusion Perform an exploratory laparotomy Leakage of amniotic fluid is an indication for hospital admission. Administer supplemental oxygen 9 Perform needle or finger decompression of the right chest Respiratory rate of 40 breaths per minute Placement of an occlusive dressing over the wound History of neurological reaction or severe hypersensitivity to the product Breath sounds The trachea is relatively short. Urgently transfer the patient to the operating room Restrict cervical motion and attempt orotracheal intubation using 2 people Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Moist heat Surgical consultation for right lower extremity fasciotomy Suction the oropharynx Repeat the primary survey and proceed with transfer Call the receiving hospital and speak to the surgeon on call Tachycardia Aspiration of bone marrow confirms appropriate positioning of the needle. avoid hypotension cardiac tamponade development of peritonitis on physical exam

Log rolling using 4 people is a safe approach to restrict spinal motion when moving her. restrict cervical motion and establish a definitive airway The head is proportionally larger in infants than in adults. Placement of a pelvic binder Positive pregnancy test, Rh negative, and has torso trauma Prepare for an exploratory thoracotomy A pulmonary contusion may be present in the absence of rib fractures. resource limitations as determined by the transferring doctor perform endotracheal intubation and ventilation fracture of the cribriform plate Log-rolling may be destabilizing to fractures from T-12 to L- a celiotomy prevent secondary brain injury hemorrhage into the chest or abdomen perform external fixation of the pelvis can be excluded by obtaining a CT of the entire spine

Massive hemothorax The patient probably has an acute epidural hematoma is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized Urinary output Warm (40°C) water control internal hemorrhage operatively definitive treatment in managing this patient is to: clinical evidence of inadequate organ perfusion must be present left hemothorax a scoop-style stretcher administer packed red blood cells Children suffer spinal cord injury without x-ray abnormality more commonly than adults percutaneous peripheral veins in the upper extremities

fetal hypoxia and distress can be confused with a tension pneumothorax tamponade of the wound with a pressure dressing endotracheal intubation and mechanical ventilation transfer the patient to the operating room, while initiating fluid therapy abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse.However, he is unconscious and has no detectable blood pressure. Optimal immediate management is to: perform endotracheal intubation produce the greatest number of survivors based on available resources. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage upper airway protection patient with a severe cardiac contusion performing a surgical cricothyroidotomy auscultate the patient's chest

a pelvic fracture and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his lower extremities. On examination in the emergency department, no movement of his lower extremities is detected, even in response to painful stimuli. The most likely cause for this finding is: aggressive fluid infusion presence of deep tendon reflexes The absolute volume of blood loss required to produce shock is the same as in adults mediastinal emphysema transfer the patient to a trauma center Neurogenic shock. 2L of crystalloid and vasopressors if BP does not respond Chest X-ray demonstrating the ETT tip positioned above the carnia Perform needle cricothyroidtomy with jet insufflations GCS beaten with a wooden stick. His chest shows multiple severe bruises. Airway is clear,

respiratory rate is 22, heart rate is 126, and systolic blood pressure is 90mm Hg. Which of the following should be performed during the primary survey? Forearm fracture Blood transfusion can be delivered through intraosseous access Chest X-ray. Re-examine the chest Presence of hemotympanum indication for CT in this patient with possible minor traumatic brain injury? X-ray of the chest and pelvis are important adjacent in his initial assessment The patient has likely impending respiratory failure following statements concerning this patient is true? Hemothorax Chemical burns require the immediate removal of clothing Reassess the position of endotracheal tube Autoregulation CBF normally occurs between cerebral perfusion pressures of 50 to 150 Control of hemorrhage Insert a definitive airway Should be combined with clinical exam, AP and odontoid, CT Pulmonary contusion

Intracranial hemorrhage will become symptomatic more quickly CT of abdomen and pelvis Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness Multiple organ failure May indicate imminent herniation from critically high ICP Rapid rewarming of the body part in circulating WARM water Decreased pulse pressure Early gastric decompression is important Traumatic brain injury Are characterized by the presence of ischemic or crushed tissue The risk of premature fetal delivery and death is reduced by the use of restraints. Are of value as part of a difficult or failed intubation plan. Monitored IV analgesia Surgical consultation next step in this patient's management is: Preparation for laparotomy while

initiating fluid resuscitation. Be with 1-2 liters of crystalloid, monitoring the patient's response CT is an important part of neurological exam level of consciousness, opens his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following concerning this patient is correct? Urethral injuries are associated with pelvic fractures. Distended neck veins Requires surgical intervention save more lives with available resources 1- triage concept : Laporatomy 2- a patient with gun shot , BP 70/0 , Chest tube drained 120 ml , chest sounds normal. next step? Tracheobronchial injury 3- persistent pneumothorax after placingchest tube. Diagnosis?- determining incomplete, or complete neurological deficit 4- which of the following is not part of the initial assessment?- retrograde urethrogram 5- echymosis in perinium , blood in meatus, what will you do? normal BP 6- Class II shock: pain medication 7- patient with minimal trauma to chest and tenderness, ABCDE are good, how to manage? excessive fluids cause cardiopulmonary failure.

8- old patient on B-blocker and Coumadin(warfarin), decreased BP, normal pulse, which of the following is true?- maxillofacial injury 9- indication for intubation? CT scan+repeat GCS assessment 10- moderate head injury- GCS 11, what to do? neurologic deficit 11-Neurogenic shock except: vasopressors 12- Neurogenic shock management: ask the patient's name 13- initial step in multiple injured pt: FAST eam 14- pt. with blunt trauma to abdomen..Decreased BP, no external bleeding: most sensitive 15- DPL: surgical cricothyroidectomy 16- unsuccessful endotracheal intubation: lateral and third ventricle 17- anatomy: choroid plexus produces CSF in the bogie 18- failed intubation: epidural hematoma 19- unconscious baby then awake then deteriorates: spinal shock

20- pt fell and can't move lower limb with sensory problem: CT with retroperitoneal air 21- laparotomy indication: escharotomy 22- circumfrential burn: flexible mediastinum 23-Pediatric: good prognosis 24- sacral sparing: ventilation 25- most common cause of acid base problem in pediatrics: 1400 ml/hr 26- 80 kg male with 50% burn and received1 L NS came after 3 hour.. What is the fluid per hour in the next 5 hours? air in mediastinum 27- X-ray of ruptured aorta except: gunshot wound to the foot 28- indication to anti-Rh in pregnant women except: Airway.. 29- pregnant lady with PV bleeding, initial assessment possible cervical injury 30- difficulty in respiration, loss of sensation in the foot?- Forearm fracture Which of the following is addressed in the secondary survey? Answer: pulmonary contusion A young male fallen from height with obvious flail chest. ABG shows pH of 7.47. what is the

cause of this abnormality? Answer: Bradycardia with irregular respirations and isolated increase in SYSTOLIC BLOOD PRESSURE.

3. Cushing's triad which occurs in cases of increased intracranial pressure? clear fluid leakage from vagina is an indication for hospitalization.

Trauma in pregnant women, do RUG

blood at the external meatus Answer: vertical shear force with posterior ligaments disruption

Scenario of pelvic fracture, which statement is correct? Answer: CT abdomen

12 year old boy sustained blunt abdominal trauma while playing football. FAST scan is positive. He is hemodynamically stable. What to do next? Answer: give analgesic. Old patient, had multiple rib fractures, splinting of the right chest, what to do? (eg >10% surface area affected transfer)

Memorize indications for burn transfer less mobility with angular acceleration and deceleration.

In comparison with young adults, elderly patients exhibit which of the following regarding brain injuries?

Answer: subcapsular hematoma of the spleen (because it is a retroperitoneal organ)

Which of the following will be missed by DPL? Answer: CT

Which of the following tests will evaluate the retroperitonium?. surgical tracheostomy in OR Patient tried to commit suicide with a rope (hyperextension of the neck), when he presented to ER he had hoarseness of voice and crepitation in the neck, what to do? Intubate.

Burn victim with signs of inhalation injury (carboneacous material, singed eyebrows) Widened symphysis pubis

Which of the followings is NORMAL in pregnancy? He has good cerebral blood flow

Trauma patient was hypotensive then you gave him 1 L of crystalloid and now he is alert and talking. Which of the following statements is correct? Le Fort III fractures

Which of the followings is a contraindication for nasal intubation? posterior displacement of tongue

Which of the followings will benefit from oropharyngeal airway? Cervical vertebral injury

Patient came with severe head injury GCS is 6 and has poor anal sphincter tone and diagrammatic breathing. His hands are flexed across the chest. What is the cause of his injury? Arachinoid and pia mater. CSF is between? Transfer after stabilizing the patient

Question about transfer? stop the bleeding with direct pressure

Scenario with scalp laceration .. the priority was to: systemic hypovolemia

Patient with head injury and systemic hypotension, what is the most probable cause of his hypotension? Carries proprioception from the same side of the body Dorsal column? ETT above carina on chest xray Which following LEAST diagnostic esophageal intubation? obtain a portable chest x-ray

5. An 18-yearold, shot, bullet wound right clavicula and right posterior axillary line, TD 11060, 90 beat, RR 34, airways and double IV line, next appropriate step? retrograde urethrography
6. A 47-year-old, falling 6 meters (20 feet) landing straddle on a face, perineum reveals extensive echymosis, blood MAE, initial diagnostic study for evaluation urinary track? narrowed pulse pressure
7. Neurogenic shock following classic characteristic except which?

Rh immunoglobulin therapy should be administered to pregnant females who have sustained a gunshot wound to the leg

8. Following false concerning Rh isoimmunization in pregnant trauma? severe maxillofacial fractures
9. Which following signs definitive airway in trauma patient? produce the greatest number of survivor based on available resources
10. Twenty-seven patient injured aircraft local airport. Principal triage? Cerebral contusions may coalesce to form an intracerebral hematoma
11. Statement correct? surgical cricothyroidotomy
12. 18-year-old motorcyclist, massive facial injuries in a head crash with pick up, 150/88, ** beats, RR 26 labored and sonor, GCS 7, orotracheal intubation unsuccesfull, be apatic, best procedure? restoration of normal perfusion
13. 24-year-old male pedestrian, struck automobile, admit EmerDeptt 1 hour after injury, 80/60, 140 beat, RR 36, lethargic, oxygen face mask, 2 IV line, BGA PaO2 118, PaCO2 30, PH 7,21. Best accomplished by? escharotomy
14. 25-year-old partial and full thickness burn involving 60% right arm and hand, circumferential burn, pulse absent right wrist and not detected by Doppler examination, first step manage right upper? mediastinal emphysema
15. Following sign chest x-ray patient a blunt injury suggest aortic rupture EXCEPT which? an epidural hematoma
16. 30-year-old woman fell down four stairs landing on concrete. Unconscious for 5 , minutes after the fall, full consciousness during 10 minute transport the hospital, GCS 15, complaint is a slight headache, 30 minute she unresponsive GCS 6 left pupil is large? ensuring adequate oxygenation and ventilation.
17. Which following first any patient may include multiple close extremity fracture? tracheobronchial injury

18. 22-year-old male falling from 2,4 meter (8 feet), large right pneumothorax chest tube inserted connected drainage, chest x-ray demonstrated residual large right pneumothorax, third x-ray reveal persistant right pneumothorax, most likely cause persistent right pneumothorax? perform a laparotomy in the operating room
19. A 30-year-old gunshot wound right lower chest, midway nipple and costal margin, in EmerDeptt he endotracheally intubated, 2 liters crystalloid two IV line, closed tube thoracostomy 200 ml of blood, his blood now 70/0, 140 beats, most appropriate? gum elastic bougle
20. You are treating trauma patient definitive airway by intubation, vocal cord not visible. Most valuable for successful intubation? vigorous fluid resuscitation may be associated with cardiorespiratory failure
21. 79-year-old female motor crash, she on Coumadin and a beta blocker. Following true? ask the patient what her name is
22. 22 year-old female 6 month pregnant motor crash, vaginal bleeding. Initial step treatment? nasotracheal tube positions a cuffed airway in the infraglottic space
23. Which following TRUE? diaphragmatic breathing in an unconscious patient who has fallen is sign of spine injury
24. Which following concerning spine and cord is TRUE? repeat the physical examination of the chest
25. 22-year-old male a shotgun wound left shoulder and chest at close range, 80/40, 130 beat, after 2 liters fluid 122/84, 100 beat, tachypneu 28 breath sound decrease upper chest with dullness on percussion, large caliber tube thoracostomy insert return 200 ml blood, most appropriate next step? FAST exam
26. Construction worker falls a scaffold, HR 124 beat, 85/60, lower abdominal pain airway, chest, immobilizing spine, initial fluid, next step? pain management
27. 40-year-old male fall from 3 meter (10 feet), airway clear, RR 28, systole 140pain on palpation of chest?