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. Given the presentation of a motor vehicle crash with a GCS of 6, dilated pupil, and contralateral weakness, it indicates severe head trauma causing impending airway compromise and the need for airway protection. Intubation will secure the airway, ensure adequate oxygenation, and prevent the risk of aspiration. Choice A (CT-scan of head) is not the immediate priority as the patient's airway needs to be secured first. Choice B (Decadron) is not indicated for acute head trauma and may even worsen brain injury. Choice D (Mannitol) may help reduce intracranial pressure, but securing the airway takes precedence in this critical situation.

Correct Answer: C

Rationale: The correct answer is C: Hyperglycemia. In a multisystem injured patient, the primary causes of depressed consciousness are related to perfusion and oxygenation. Hyperglycemia, while a concern, is less likely to directly cause a depressed level of consciousness compared to shock, head injury, and impaired oxygenation. Hyperglycemia may lead to symptoms like confusion or weakness, but it typically does not result in a significant decrease in consciousness level. Therefore, in the context of a multisystem injured patient, hyperglycemia is the least likely cause of a depressed level of consciousness.

Correct Answer: B

Rationale: Correct Answer: B - Insert a definitive airway Rationale: 1. Patient has a low GCS of 8, indicating impaired consciousness and airway protection. 2. Obesity can further complicate airway management during sedation. 3. Inserting a definitive airway ensures adequate oxygenation and ventilation. 4. CT scan can cause respiratory depression, necessitating secure airway before transfer. 5. Multilumen esophageal airway is not indicated as it does not secure the airway. 6. Sedative drugs should be used cautiously due to the risk of respiratory depression. 7. Lateral cervical spine film is not necessary before CT scan in this scenario.

Correct Answer: C

Rationale: The correct answer is C: "FAST exam." In this scenario, the patient presents with signs of hypovolemic shock following a chest stab wound. The FAST exam (Focused Assessment with Sonography in Trauma) is crucial for rapid identification of intra-abdominal bleeding, which can occur concurrently with thoracic injuries. It is a quick and non-invasive bedside ultrasound assessment that can detect free fluid in the pericardial, pleural, and peritoneal spaces. Identifying intra-abdominal bleeding is important as it may require emergent surgical intervention to prevent further deterioration. Choice A, "CT scan of the chest," would take more time and is not the immediate priority in a hemodynamically unstable patient. Choice B, "12 lead ECG," is important in assessing for cardiac injury but is not the most critical step in this scenario. Choice D, "Begin infusion of RBCs," may be necessary later but addressing the source of bleeding and volume status through

Correct Answer: C

Rationale: The correct answer is C because the chain of command represents the hierarchical structure within an organization, outlining who reports to whom. It ensures clear communication, accountability, and efficient decision-making. Option A is incorrect as it refers to legal liability. Option B is incorrect as it only refers to the department head, not the entire structure. Option D is incorrect as it focuses on reporting a problem rather than the overall structure of authority.