A young man sustains a gunshot wound to the abdomen. The definitive treatment in managing this patient is to:

Correct Answer: C

Rationale: The correct answer is C: Control internal hemorrhage operatively. In cases of gunshot wounds to the abdomen, the priority is to control internal bleeding through surgical intervention. This is crucial to prevent hypovolemic shock and potential complications. Administering O-negative blood (choice A) is important for resuscitation but is not the definitive treatment. Applying external warming devices (choice B) is not the primary concern in this scenario. Using a pneumatic antishock garment (PASG) (choice D) may be used in some cases but is not the definitive treatment for managing internal hemorrhage. Operating to control the bleeding is essential for the patient's survival.

Correct Answer: D

Rationale: The correct answer is D - Less brain contusions. The scenario described suggests a rapid deterioration in neurological status after an initial period of lucidity, indicating the possibility of a traumatic brain injury. The presence of a large left pupil suggests uncal herniation, which can be due to increased intracranial pressure from brain contusions. The sudden decline in GCS from 15 to 6 further supports this. The lack of focal neurological signs like flail chest or pulmonary contusion makes choices A and C less likely. Choice B is unrelated to the scenario provided. Therefore, the most likely explanation for the patient's worsening condition is the development of brain contusions leading to increased intracranial pressure and subsequent herniation.

Correct Answer: D

Rationale: Tension pneumothorax is a life-threatening condition caused by trapped air in the pleural space, leading to increased pressure in the chest cavity. "Flail chest" can result in lung puncture and subsequent pneumothorax. Cardiac tamponade can compress the heart and cause air to enter the pleural space. Clamping a chest tube can prevent air from escaping, leading to tension pneumothorax. Therefore, the correct answer is D, as all choices can potentially cause tension pneumothorax by different mechanisms.

Correct Answer: A

Rationale: The correct answer is A because in the treatment of thermal injuries, immediate removal of clothing is crucial to stop the heat source and prevent further damage to the skin. Removing clothing also allows for a quick assessment of the extent of the burn and initiation of appropriate treatment. Choice B is incorrect as patients with thermal injuries are at risk for hypothermia due to heat loss from damaged skin. Choice C is incorrect as fasciotomies are not typically indicated for circumferential truncal burns unless there is evidence of compartment syndrome. Choice D is incorrect as electrical burns can lead to deep tissue injury but are not always associated with extensive skin necrosis from entry to exit points.

Correct Answer: D

Rationale: The correct answer is D: Care that it determines to be medically necessary. Medicare covers services that are deemed medically necessary based on established guidelines and standards. This ensures that resources are used efficiently and appropriately to improve patient outcomes. Choices A, B, and C are incorrect because Medicare does not cover all care requested by the recipient, doctor, or facility without considering medical necessity. It is crucial for Medicare to prioritize coverage for services that are essential for the patient's health and well-being.