Management of severe head injury with GCS 6, BP 140/90 mmHg, intubated:

Correct Answer: B

Rationale: The correct answer is B: "Prevent secondary brain injury." In a patient with severe head injury (GCS 6), preventing secondary brain injury is crucial. This involves maintaining adequate cerebral perfusion pressure, controlling intracranial pressure, optimizing oxygenation, and avoiding factors that can exacerbate brain injury. Administering an osmotic diuretic (choice A) may help reduce intracranial pressure but does not address the overall goal of preventing secondary brain injury. Aggressively treating systemic hypertension (choice C) may lead to decreased cerebral perfusion and worsen the injury. Reducing metabolic requirements of the brain (choice D) is important but not the primary goal in this acute phase.

Correct Answer: A

Rationale: The correct answer is A: "Moist heat" for treating frostbite. Moist heat helps to slowly rewarm the affected area, promoting blood flow and preventing further tissue damage. It is recommended to soak the frostbitten area in warm water (not hot) for about 20-30 minutes until normal color and sensation return. Choice B: Early amputation is incorrect as it is an extreme measure and should only be considered as a last resort when there is no other option to save the limb. Choice C: Padding and elevation can help reduce swelling and pain, but it is not the primary treatment for frostbite. Choice D: Vasodilators and heparin are not recommended for treating frostbite as they may increase the risk of complications. It is crucial to prioritize rewarming the affected area with moist heat for proper treatment.

Correct Answer: C

Rationale: The correct answer is C: Chest x-ray. In this scenario, the patient is at risk for thoracic injuries due to the motor vehicle crash and the need for mechanical ventilation. A chest x-ray is essential to assess for potential life-threatening conditions such as pneumothorax, hemothorax, or pulmonary contusions. This information is crucial for the safe transfer of the patient to another facility. A: FAST exam is typically used to assess for intra-abdominal bleeding and is not mandatory in this case. B: Lateral cervical spine x-ray is not necessary as the patient is already in full spinal protection and needs definitive neurosurgical care, not initial evaluation. D: Administration of methylprednisolone is not mandatory at this stage and should be based on specific guidelines for spinal cord injury management.

Correct Answer: B

Rationale: The correct answer is B: "Preparation for laparotomy while initiating fluid resuscitation". In a trauma scenario with hemodynamic instability like this, the priority is to address potential intra-abdominal bleeding with a laparotomy. Fluid resuscitation is crucial to maintain perfusion and stabilize the patient before surgery. The other choices are incorrect because: A: "Transfusion of FFP and platelets" is not the immediate priority in this scenario as it does not address the source of bleeding. C: "Resuscitation with crystalloid and pRBC until base excess is normal" is not ideal as it delays definitive treatment and may worsen the patient's condition. D: "Fluid resuscitation and angioembolization" may be considered in stable patients, but in this case, the patient is hemodynamically unstable and needs immediate surgical intervention.

Correct Answer: D

Rationale: The correct answer is D: The resident. Residents are the focal point of care, and their needs and preferences should guide the care team. Physicians provide medical expertise but residents are the primary recipients of care. Nurses and nursing assistants play crucial roles in providing direct care, but ultimately, the resident's well-being is the top priority.