Which of the following would be an early sign of a possible aortic dissection?

Correct Answer: C

Rationale: Step-by-step rationale for answer C: An early sign of a possible aortic dissection is a blood pressure difference of 20 mmHg or more in the upper extremities due to impaired blood flow. This discrepancy occurs because the dissection can obstruct blood flow to one of the brachial arteries, leading to a difference in blood pressure readings between the arms. This sign is a result of the aortic dissection affecting the arterial blood supply to the upper extremities. Summary of incorrect choices: A: A narrowing pulse pressure and tachycardia - These symptoms are more commonly associated with conditions like shock or dehydration, not specifically indicative of aortic dissection. B: A sudden rise in systolic blood pressure and fall in diastolic blood pressure - While changes in blood pressure can occur in aortic dissection, the specific pattern described here is not a typical early sign. D: A reddish-blue discoloration of the skin above the shoulders - Skin discolor

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: B

Rationale: The correct immediate effort for a severely comminuted, open, distal right femur fracture in a 30-year-old man is to tamponade the wound with a pressure dressing (Choice B). This helps control bleeding and prevent further contamination. Immediate angiography (Choice A) is not necessary as controlling bleeding and stabilizing the patient is the priority. Wound exploration and removal of bony fragments (Choice C) should be done after initial stabilization to prevent further damage. Realignment of the fracture segments with a traction splint (Choice D) should also be done after initial wound management to avoid exacerbating the injury.

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.