Motor vehicle crash, GCS 6, dilated pupil, contralateral weakness, next step?

Correct Answer: C

Rationale: The correct next step is to perform endotracheal intubation (Choice C). In this scenario, the patient's presentation with a GCS of 6, dilated pupil, and contralateral weakness indicates significant neurological compromise likely due to increased intracranial pressure. Endotracheal intubation is crucial to protect the airway and ensure adequate oxygenation and ventilation in such critical conditions. Administering medications or performing diagnostic tests like a CT-scan (Choice A), decadron (Choice B), or mannitol (Choice D) should be secondary to securing the airway and stabilizing the patient's condition.

Correct Answer: C

Rationale: The correct answer is C: Hyperglycemia. In a multisystem injured patient, hyperglycemia is the least likely cause of a depressed level of consciousness because it typically does not directly affect brain function or consciousness. Shock (A), head injury (B), and impaired oxygenation (D) are more likely to cause a depressed level of consciousness in this patient population due to their direct impact on brain perfusion, injury, and oxygen delivery, respectively. Hyperglycemia, although an important consideration in the critically ill patient, is not a primary driver of altered consciousness in the setting of multisystem trauma.

Correct Answer: B

Rationale: The correct answer is B: Insert a definitive airway. In a patient with a GCS of 8, airway management is a priority. Inserting a definitive airway ensures proper oxygenation and ventilation during the CT scan, reducing the risk of hypoxia or respiratory compromise. This step takes precedence over giving more sedative drugs (A), as ensuring adequate oxygenation is critical in a patient with altered mental status. Inserting a multilumen esophageal airway (C) is not indicated in this scenario, as it is primarily used for airway management during surgery. Requesting a lateral cervical spine film (D) is not necessary before a CT scan in this case, as securing the airway takes precedence over ruling out cervical spine injury.

Correct Answer: C

Rationale: The correct answer is C: "FAST exam." In this scenario, the patient presents with signs of hypovolemic shock likely due to internal bleeding from the chest wound. FAST exam (Focused Assessment with Sonography in Trauma) is a rapid bedside ultrasound used to assess for free fluid in the abdomen or pericardium, which can help identify the source of bleeding. This is crucial for immediate management as it can guide further interventions such as surgery or angiography. Choice A: "CT scan of the chest" is not the most immediate step as it takes time and may not provide rapid information needed for immediate management. Choice B: "12 lead ECG" is not the priority in this situation as the patient is hemodynamically unstable and requires rapid assessment for potential life-threatening bleeding. Choice D: "Begin infusion of RBCs" is important, but identifying the source of bleeding is crucial before deciding on the need for blood transfusion.

Correct Answer: C

Rationale: The correct answer is C because the chain of command refers to the hierarchical structure within an organization that outlines the line of authority and communication. This ensures that decisions and information flow efficiently from top management to frontline employees. Option A is incorrect as it describes legal responsibility. Option B is incorrect as it refers to a shift supervisor, not the entire chain of command. Option D is incorrect as it describes a specific department, not the overall structure of authority. Ultimately, understanding the chain of command is crucial for effective communication and decision-making within an organization.