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. Needle decompression is the standard treatment for tension pneumothorax, a life-threatening condition causing respiratory distress. 2. The patient's symptoms (shortness of breath, jugular vein distension, decreased breath sounds, falling blood pressure) are indicative of tension pneumothorax. 3. Repeated attempts to relieve pressure at the occlusive dressing have failed, suggesting a need for more definitive intervention. 4. A longer catheter (2-2.5 inches) is recommended to ensure proper decompression. Summary: A: Removing the occlusive dressing and pulling the wound open could worsen the tension pneumothorax by allowing more air into the chest. B: Translaryngeal Jet Ventilation is not indicated for tension pneumothorax and may delay appropriate treatment

Correct Answer: A

Rationale: The correct initial step in managing a head-injury patient is to secure the airway. This is crucial to ensure adequate oxygenation and ventilation, which are essential for the patient's survival. Without a patent airway, the patient may suffer from hypoxia and respiratory distress. Obtaining a c-spine film or controlling scalp hemorrhage can be important but are secondary to securing the airway. Supporting the circulation is also vital, but airway management takes precedence as it directly impacts oxygen delivery to the brain. Therefore, securing the airway should be the primary focus in managing a head-injury patient.

Correct Answer: C

Rationale: The correct answer is C: The shock in this scenario is consistent with blood loss from bilateral femoral fracture. Rationale: 1. Bilateral femoral fractures can lead to significant blood loss due to injury to major blood vessels in the thighs, causing hypovolemic shock. 2. The deformities, marked swelling, and absence of open wounds point towards significant internal bleeding. 3. The shock is likely due to the blood loss from the femoral fractures, making choice C the most appropriate. Summary: A: Pelvic fracture may cause shock, but in this case, the femoral fractures are more likely the primary source of blood loss. B: Loss of 15% blood volume is not significant enough to cause the severe shock observed in this patient. D: Applying traction splints may stabilize the fractures but will not directly address the underlying blood loss causing the shock.

Correct Answer: A

Rationale: The correct answer is A: "Gum elastic bougie." When the vocal cords are not visible during intubation, a bougie is valuable for navigating the airway and guiding the endotracheal tube. Step 1: Use the bougie to feel for the tracheal rings. Step 2: Advance bougie until resistance is felt. Step 3: Thread the endotracheal tube over the bougie. Step 4: Remove the bougie. The other choices are incorrect because B (x-ray) does not directly aid in intubation, C (nasopharyngeal airway) is not useful when vocal cords are not visible, and D (oxygen) is important but not a tool for intubation.

Correct Answer: B

Rationale: The correct answer is B because limb-threatening extremity injuries, such as fractures or dislocations, require definitive management to prevent further damage and preserve limb function. Application of a traction splint helps stabilize the injury, reduce pain, and prevent complications like nerve or vascular damage. A tourniquet (choice A) should only be used in life-threatening situations with uncontrolled bleeding. Limb-threatening injuries can present without open wounds (choice C) and may not always involve ischemic or crushed tissue (choice D), making these options incorrect.