A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the ED he is diaphoretic and complaining of chest pain. His BP is 60/40mmHg 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?

Correct Answer: C

Rationale: The correct answer is C: Breath sounds. In cardiac tamponade, there may be muffled heart sounds and distant or absent breath sounds due to the accumulation of fluid around the heart, compressing the lungs. This differentiates it from tension pneumothorax, where there is hyperresonance to percussion and decreased or absent breath sounds on the affected side. A: Tachycardia is a common feature of both cardiac tamponade and tension pneumothorax, so it does not differentiate between the two conditions. B: Pulse volume may be decreased in both cardiac tamponade and tension pneumothorax, so it is not the best differentiator. D: Pulse pressure may be narrowed in both conditions, so it is not the most specific differentiating factor.

Correct Answer: D

Rationale: The correct answer is D: Presence of hemotympanum. Hemotympanum is a significant finding that suggests a basilar skull fracture, which can lead to intracranial injury. CT is indicated to assess for potential brain injury in this case, despite the patient's initial normal vital signs and GCS score. A: Blood alcohol concentration is not an indication for CT in this scenario unless it affects the patient's mental status. B: An isolated scalp laceration does not necessarily indicate a need for CT unless there is suspicion of underlying skull fracture. C: A mandibular fracture is not directly related to the need for CT in this case, as it primarily affects the facial bones.

Correct Answer: A

Rationale: The correct answer is A because initial resuscitation in adult patients should start with 1-2L of crystalloid to restore intravascular volume. This helps improve tissue perfusion and oxygen delivery. Monitoring the patient's response (B) is important but not the initial step. Using crystalloid to normalize BP (C) may lead to fluid overload. Permissive hypotension in patients with head injury (D) is contraindicated as it can worsen cerebral perfusion.

Correct Answer: A

Rationale: The correct answer is A: The nurse. Nurses have the education and training to assess residents, monitor progress, administer treatments, and medication. They play a crucial role in coordinating care and ensuring the well-being of residents. Nursing assistants provide hands-on care but do not assess or administer medications. Medical social workers focus on psychosocial needs, not direct medical care. Registered dietitians specialize in nutrition and dietary needs, not direct patient assessment or medication administration.

Correct Answer: C

Rationale: The correct answer is C: Investigating and resolving resident complaints. Ombudsmen are designated to address concerns and complaints from residents in a fair and unbiased manner. They advocate for residents' rights and work to resolve issues within long-term care facilities. Choice A and B are incorrect as they involve tasks typically handled by staff members or managers, not ombudsmen. Choice D is incorrect as organizing outings and activities is not a primary responsibility of an ombudsman, whose focus is on addressing complaints and ensuring quality of care.