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 managing a gunshot wound to the abdomen, the priority is to control internal bleeding, usually through surgical intervention. Administering O-negative blood (A) is important for resuscitation but does not address the primary issue. External warming devices (B) are not the priority in this scenario. Applying a pneumatic antishock garment (PASG) (D) is not recommended as it could delay necessary surgical intervention to control hemorrhage. Operating to control internal hemorrhage is crucial to prevent further blood loss and stabilize the patient's condition.

Correct Answer: D

Rationale: The correct answer is D, less brain contusions. The scenario describes a traumatic brain injury likely due to the fall. The initial GCS of 15 indicates mild TBI, which deteriorated rapidly to GCS 6 and a large left pupil, suggesting brain herniation. The sudden decline in neurological status, particularly with a focal sign like a dilated pupil, is more indicative of diffuse axonal injury (DAI) or brain herniation rather than epidural hematoma or pulmonary contusion. The absence of any mention of focal neurological deficits or direct trauma to the chest makes choices A and C less likely. Choice B is unrelated to the scenario.

Correct Answer: D

Rationale: The correct answer is D, "All of the above." Tension pneumothorax can be caused by a variety of factors, including "Flail chest," which leads to air accumulation in the pleural space. Cardiac tamponade can also cause tension pneumothorax due to increased pressure on the lungs. Clamping of a chest tube can result in tension pneumothorax if the built-up air cannot escape. Therefore, all of these choices can lead to tension pneumothorax by causing an increase in intrathoracic pressure, ultimately leading to respiratory distress.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. In cases of thermal injury, immediate removal of clothing is crucial to stop the burning process and prevent further damage. 2. Clothing can retain heat and continue to burn the skin, exacerbating the injury. 3. Removing clothing also allows for a thorough assessment of the extent of the burn and enables proper treatment. 4. Prompt removal of clothing is a standard protocol in the initial management of thermal injuries. Summary of why other choices are incorrect: B. Patients with thermal injuries are at higher risk for hypothermia due to loss of skin integrity and body heat, not lower risk. C. Fasciotomies are typically needed for patients with compartment syndrome, not circumferential truncal burns. D. Electrical burns can cause tissue necrosis along the path of the current, not necessarily extensive skin necrosis from entry to exit points.

Correct Answer: D

Rationale: The correct answer is D: Medicare will pay for care that it determines to be medically necessary. Medicare follows guidelines to determine what services are medically necessary based on the patient's condition. This ensures appropriate and effective use of resources. Choices A, B, and C are incorrect because Medicare does not cover all care simply because it is requested by the recipient, doctor, or facility. It must meet the criteria of being medically necessary to be covered by Medicare.