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 or distant heart sounds due to the accumulation of fluid around the heart, impacting its ability to pump effectively. In tension pneumothorax, breath sounds may be absent or decreased on the affected side due to lung collapse. This differentiation is important as cardiac tamponade requires emergent pericardiocentesis, while tension pneumothorax necessitates needle decompression. Choices A, B, and D are not as useful in differentiating between the two conditions. Tachycardia may be present in both conditions, pulse volume may be decreased in both, and pulse pressure may be narrowed in both due to decreased cardiac output. Breath sounds are a key differentiating factor in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Presence of hemotympanum. Hemotympanum is indicative of a basilar skull fracture, which can lead to intracranial bleeding and brain injury. CT scan is necessary to evaluate for intracranial injuries in this case. A: Blood alcohol concentration is not an indication for CT in this scenario. B: A scalp laceration alone does not warrant a CT scan for traumatic brain injury. C: Mandibular fracture does not directly indicate traumatic brain injury and is not a reason for CT in this case.

Correct Answer: A

Rationale: The correct answer is A because initial resuscitation in adult patients should focus on restoring intravascular volume, which is effectively achieved with 1-2L of crystalloid fluids. This helps improve tissue perfusion and overall hemodynamics. Monitoring the patient's response (choice B) is important but secondary to the immediate need for volume replacement. Using crystalloid to normalize blood pressure (choice C) is not recommended as the sole goal, as other factors like tissue perfusion also need to be considered. Permissive hypotension (choice D) is contraindicated in patients with head injury as it can worsen brain perfusion.

Correct Answer: A

Rationale: The correct answer is A: The nurse. Nurses are trained to assess residents, monitor their progress, and administer treatments and medication. They have the expertise and knowledge to provide comprehensive care. Nursing assistants (B) assist with daily living activities but do not have the same scope of practice. Medical social workers (C) focus on social and emotional aspects of care. Registered dietitians (D) specialize in nutrition management, not direct patient care like assessing and administering treatments. Thus, the nurse is the most appropriate member of the care team for these responsibilities.

Correct Answer: C

Rationale: The correct answer is C: Investigating and resolving resident complaints. An ombudsman's primary responsibility is to advocate for residents in long-term care facilities, ensuring their rights are upheld and addressing any concerns or complaints they may have. Ombudsmen investigate complaints, mediate disputes, and work towards resolving issues to improve the quality of care for residents. Choices A, B, and D are incorrect because they do not align with the core duties of an ombudsman, which focus on protecting residents' rights and addressing complaints rather than specific care procedures, staff disputes, or recreational activities.