Motorcycle crash, noisy respirations, apneic, hematoma in pharynx, airway management?

Correct Answer: A

Rationale: The correct answer is A: "Inserting an oropharyngeal airway." In this scenario of a motorcycle crash with noisy respirations, apnea, and a hematoma in the pharynx, the patient is likely experiencing airway obstruction. An oropharyngeal airway helps maintain a patent airway by preventing the collapse of the tongue and soft tissues in the oropharynx. It does not require visualization or manipulation of the upper airway structures, making it the most suitable initial intervention in this emergent situation. Summary of why the other choices are incorrect: B: "Inserting a nasopharyngeal airway" - Nasopharyngeal airways are not recommended in the presence of facial trauma or suspected basilar skull fracture due to the risk of exacerbating the injury. C: "Performing a surgical cricothyroidotomy" - This is an invasive procedure reserved for extreme cases of airway obstruction when other methods fail. D

Correct Answer: B

Rationale: The correct answer is B - Undergo prompt celiotomy. In this scenario, the presence of diffuse abdominal tenderness and free air on abdominal films indicates a high likelihood of intraabdominal injury, likely due to a gastrointestinal perforation. Prompt celiotomy (surgical exploration of the abdomen) is necessary to identify and repair the source of the perforation to prevent sepsis and other complications. Peritoneal lavage (choice A) is not sufficient for definitive diagnosis and treatment. Contrast x-ray (choice C) delays necessary surgical intervention. Simply observing (choice D) can be dangerous as the patient may deteriorate rapidly. Celiotomy allows for immediate intervention and management of the life-threatening condition.

Correct Answer: D

Rationale: The correct answer is D because cerebral blood flow is directly influenced by PaCO2 levels. When PaCO2 is below 30-50mmHg, cerebral blood vessels constrict, leading to decreased cerebral blood flow. This vasoconstriction is a protective mechanism to prevent excessive blood flow and maintain stable cerebral perfusion pressure. Therefore, the statement that cerebral blood flow is increased when PaCO2 is below 30-50mmHg is true. Explanation for why the other choices are incorrect: A: Hypotonic fluids can exacerbate brain edema by causing fluid shifts, so they should not be used to limit brain edema in severe head injury. B: Elevated intracranial pressure impairs cerebral perfusion due to decreased perfusion pressure gradient, leading to decreased cerebral blood flow. C: CSF can be displaced from the cranial vault due to changes in intracranial pressure and volume shifts.

Correct Answer: D

Rationale: The correct answer is D because retroperitoneal air on CT indicates a hollow viscus injury, such as a bowel perforation, which requires immediate surgical exploration. A is incorrect because a seat belt sign alone does not necessitate surgery. B is incorrect as grade 4 hepatic injury may not always require laparotomy. C is incorrect as extraperitoneal bladder injury can often be managed conservatively.

Correct Answer: A

Rationale: The correct answer is A: The nursing assistant. Nursing assistants provide direct care to residents, such as assisting with activities of daily living and personal care needs. They spend the most time with residents compared to other members of the care team. Nurses oversee the care but may not have direct contact as frequently. Physicians focus on medical treatment, not daily care. Activities directors organize recreational activities but do not provide personal care. Therefore, the nursing assistant has the most direct contact with residents.