Several minutes after sealing your adult trauma patient's sucking chest wound with an occlusive dressing secured on three sides, he begins to experience increasing shortness of breath, jugular vein distension, decreasing unilateral breath sounds on the affected side, and his blood pressure is less than 90 systolic and falling. Repeated attempts to relieve the pressure at the occlusive dressing have proven ineffective. At this point, which of the following should be initiated?

Correct Answer: D

Rationale: The correct answer is D: Immediate needle decompression using a 10- or 14-gauge catheter that is at least 2 or 2.5 inches long. Rationale: 1. Symptoms indicate tension pneumothorax, a life-threatening condition where air accumulates in the pleural space, causing pressure on the heart and lungs. 2. Needle decompression is the immediate intervention for tension pneumothorax to release trapped air and relieve pressure. 3. A longer catheter is needed to ensure successful decompression. 4. Translaryngeal Jet Ventilation (Choice B) is not recommended as it does not address the underlying issue of trapped air. 5. Endotracheal intubation (Choice C) may delay definitive treatment and worsen the patient's condition. 6. Removing the occlusive dressing (Choice A) without proper decompression can further exacerbate tension pneumothorax. Summary: Immediate needle decompression is crucial to treat tension pneumoth

Correct Answer: A

Rationale: The correct initial step in managing a head-injury patient is to secure the airway (Choice A). This is crucial for ensuring adequate oxygenation and ventilation. Without a patent airway, the patient may suffer from hypoxia, leading to further brain injury. Obtaining c-spine film (Choice B) is important but not the most immediate concern. Supporting circulation (Choice C) is vital but comes after ensuring airway patency. Controlling scalp hemorrhage (Choice D) is also important but does not take precedence over securing the airway in the initial management of a head-injury patient.

Correct Answer: C

Rationale: Step 1: The scenario describes a man pinned by a cement truck with deformities and swelling in both thighs, indicating significant trauma. Step 2: The absence of open wounds suggests internal bleeding as the cause of shock. Step 3: Bilateral femoral fractures can lead to significant blood loss, resulting in shock. Step 4: Therefore, the shock is consistent with blood loss from bilateral femoral fractures, making choice C the correct answer. Step 5: The other choices are incorrect because shock in this case is more likely due to internal bleeding rather than pelvic fracture (A), fixed percentage blood loss (B), or traction splints (D).

Correct Answer: A

Rationale: The correct answer is A: "Gum elastic bougie." In difficult intubation situations where vocal cords are not visible, a bougie is essential. Step 1: Insert the bougie into the trachea until resistance is felt. Step 2: Advance the endotracheal tube over the bougie. Step 3: Remove the bougie. This technique helps guide the endotracheal tube into the trachea successfully. The other choices are incorrect. B: Lateral cervical spine x-ray is not useful for intubation. C: Nasopharyngeal airway is for maintaining airway patency, not for intubation. D: Oxygen does not aid in intubation directly.

Correct Answer: B

Rationale: The correct answer is B. Limb-threatening extremity injuries should be definitively managed with a traction splint to stabilize and immobilize the limb, preventing further damage and reducing the risk of complications. This method helps to maintain proper alignment, reduce pain, and minimize the potential for neurovascular compromise. A: Requiring a tourniquet is not always necessary and may lead to complications such as tissue damage. C: Limb-threatening injuries can occur without an open wound, especially in cases of blunt trauma. D: Limb-threatening injuries can include a range of conditions beyond just ischemic or crushed tissue, so this statement is too narrow.