What is the name of the legal document in which an individual specifies what medical treatments should and should not be done for him in the event he is unable to make his own medical care decisions?

Correct Answer: C

Rationale: The correct answer is C: An advanced directive. This legal document allows an individual to specify their preferences for medical treatments in case they are unable to make decisions. It includes instructions on what treatments to receive or avoid. A DNR order (choice A) specifically pertains to resuscitation preferences only. A will (choice B) outlines the distribution of assets after death, not medical care decisions. Personal directive (choice D) is not a commonly used term for this type of legal document.

Correct Answer: D

Rationale: The correct answer is D: Endotracheal intubation and mechanical ventilation. In the case of a flail chest, where multiple ribs are fractured causing a segment of the chest wall to move independently from the rest of the thorax, the patient is at high risk of respiratory compromise. Endotracheal intubation and mechanical ventilation are necessary to ensure adequate oxygenation and ventilation, as the flail segment impairs the ability of the chest wall to expand effectively. High-flow oxygen via a nonrebreathing mask alone may not be sufficient to support the patient's respiratory needs. Choice A is incorrect because the patient's confusion is likely due to inadequate oxygenation and ventilation, not fluid resuscitation. Choice B is incorrect because cyanosis is a late sign of respiratory distress and should not be solely relied upon for management decisions. Choice C is incorrect as tachypnea is a compensatory mechanism and not a definitive management strategy for a flail chest.

Correct Answer: D

Rationale: The correct answer is D - Less brain contusions. The scenario described suggests a rapid deterioration in neurological status after an initial period of lucidity, indicating the possibility of a traumatic brain injury. The presence of a large left pupil suggests uncal herniation, which can be due to increased intracranial pressure from brain contusions. The sudden decline in GCS from 15 to 6 further supports this. The lack of focal neurological signs like flail chest or pulmonary contusion makes choices A and C less likely. Choice B is unrelated to the scenario provided. Therefore, the most likely explanation for the patient's worsening condition is the development of brain contusions leading to increased intracranial pressure and subsequent herniation.

Correct Answer: D

Rationale: Tension pneumothorax is a life-threatening condition caused by trapped air in the pleural space, leading to increased pressure in the chest cavity. "Flail chest" can result in lung puncture and subsequent pneumothorax. Cardiac tamponade can compress the heart and cause air to enter the pleural space. Clamping a chest tube can prevent air from escaping, leading to tension pneumothorax. Therefore, the correct answer is D, as all choices can potentially cause tension pneumothorax by different mechanisms.

Correct Answer: A

Rationale: The correct answer is A because in the treatment of thermal injuries, immediate removal of clothing is crucial to stop the heat source and prevent further damage to the skin. Removing clothing also allows for a quick assessment of the extent of the burn and initiation of appropriate treatment. Choice B is incorrect as patients with thermal injuries are at risk for hypothermia due to heat loss from damaged skin. Choice C is incorrect as fasciotomies are not typically indicated for circumferential truncal burns unless there is evidence of compartment syndrome. Choice D is incorrect as electrical burns can lead to deep tissue injury but are not always associated with extensive skin necrosis from entry to exit points.