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

Correct Answer: A

Rationale: The correct answer is A: "Inserting an oropharyngeal airway" because noisy respirations and apnea indicate airway obstruction. Oropharyngeal airway can help maintain a patent airway by preventing the collapse of soft tissues in the pharynx. It does not require visualization of the airway (unlike nasopharyngeal airway or intubation methods), making it quicker and suitable for emergency situations. Surgical cricothyroidotomy is an invasive procedure and not indicated in this scenario. Fiberoptic-guided nasotracheal intubation is time-consuming and may not be feasible in a critical situation.

Correct Answer: B

Rationale: The correct answer is B, "Undergo prompt celiotomy." This is because the presence of free air on abdominal films in a seat-belted driver with diffuse abdominal tenderness indicates a likely intra-abdominal injury requiring surgical intervention. Prompt celiotomy allows for exploration of the abdomen to identify and repair any internal injuries. Choice A, peritoneal lavage, is not recommended as it does not provide definitive treatment for the underlying intra-abdominal injury. Choice C, contrast x-ray of the GI-tract, is unnecessary and delays definitive management. Choice D, observation for further evidence of intraabdominal injury, is not appropriate given the already identified signs of a serious abdominal injury that require immediate surgical intervention.

Correct Answer: D

Rationale: Rationale for Answer D: Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg 1. Cerebral blood flow is primarily regulated by PaCO2 levels. 2. When PaCO2 is below 30-50mmHg, it causes cerebral vasoconstriction, reducing blood flow. 3. Higher PaCO2 levels above this range lead to cerebral vasodilation and increased blood flow. 4. Therefore, the statement that cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg is true. Summary: A: Incorrect - Hypertonic fluids, not hypotonic, are used to reduce brain edema in severe head injury. B: Incorrect - Elevated intracranial pressure can impair cerebral perfusion due to decreased pressure gradients. C: Incorrect - CSF can be displaced from the cranial vault in conditions like hydrocephalus or

Correct Answer: D

Rationale: The correct answer is D because retroperitoneal air on CT indicates a significant injury such as a hollow viscus perforation, which requires immediate laparotomy. Choice A, a distinct seat belt sign, may indicate abdominal injury but does not always necessitate surgery. Choice B, a grade 4 hepatic injury, can often be managed conservatively. Choice C, extraperitoneal bladder injury, can be managed non-operatively unless there are associated injuries. In summary, retroperitoneal air on CT is a strong indicator of a surgical emergency, while the other choices may not require immediate laparotomy.

Correct Answer: A

Rationale: The correct answer is A: The nursing assistant. Nursing assistants have the most direct contact with residents as they provide daily care, assist with activities of daily living, and offer emotional support. They spend more time with residents compared to nurses, physicians, or activities directors. Nurses mainly focus on clinical assessments and medication administration, physicians on medical diagnosis and treatment, and activities directors on planning recreational activities. Nursing assistants have continuous hands-on interaction with residents, making them the primary caregivers in long-term care settings.