You are called to assist a 20-year-old male for a severe headache. On-scene, you learn the patient was involved in an accident that caused a potential closed head injury. However, at the time of the accident, the patient refused EMS care, stating he felt fine. Today, he is experiencing headache, confusion, and visual disturbances. Which of the following injuries is most likely to cause this type presentation?

Correct Answer: C

Rationale: Rationale: The correct answer is C: Subdural hematoma. Subdural hematoma is a collection of blood between the dura mater and arachnoid mater of the brain, often caused by head trauma. Symptoms include headache, confusion, and visual disturbances, which align with the patient's presentation. Subdural hematomas can develop gradually after a head injury, leading to delayed symptoms. Other choices: A: Coup-contra-coup injury - This injury involves the brain hitting the skull on both sides due to acceleration-deceleration forces, but it typically presents with focal neurological deficits rather than the diffuse symptoms described. B: Diffuse axonal injury - This injury involves widespread damage to nerve fibers in the brain, leading to coma or altered consciousness rather than confusion and visual disturbances. D: Epidural hematoma - This injury is a collection of blood between the skull and dura mater, typically causing rapid deterioration in mental status and focal neurological deficits, not confusion

Correct Answer: C

Rationale: The correct answer is C because a negative Kleihauer-Betke test does not completely exclude Rh-isoimmunization in pregnant trauma patients. The test is used to estimate the amount of fetal-maternal hemorrhage and guide Rhogam administration, but it is not foolproof. Trauma can cause significant fetal-maternal hemorrhage, leading to Rh-isoimmunization even if the test initially shows negative results. Choice A is incorrect because Rh-isoimmunization can indeed occur in both blunt and penetrating abdominal trauma. Choice B is incorrect as even minor degrees of fetomaternal hemorrhage can lead to Rh-isoimmunization. Choice D is incorrect as Rh-isoimmunization is a concern in both Rh-negative and Rh-positive pregnant trauma patients due to the potential for fetal-maternal hemorrhage.

Correct Answer: D

Rationale: Correct Answer: D Rationale: 1. Children have less circulating blood volume than adults, so a smaller volume of blood loss can lead to shock. 2. Pediatric shock can occur with as little as 5-10% blood loss, whereas adults typically require 15-30%. 3. This difference is due to children's smaller body size and lower blood volume compared to adults. 4. Therefore, the statement that the absolute volume of blood loss required to produce shock is the same as in adults is FALSE. Summary of other choices: A: True - Vital signs in children vary with age. B: True - Children have greater physiologic reserves compared to adults. C: True - Tachycardia is a common response to hypervolemia in pediatric shock.

Correct Answer: A

Rationale: The correct answer is A: "Permissive hypotension and early plasma infusion." This principle of balanced resuscitation involves allowing for slightly lower blood pressure to reduce bleeding while promptly providing plasma to restore clotting factors. Permissive hypotension helps prevent further blood loss, while early plasma infusion helps maintain coagulation function. The other choices are incorrect because B does not address the specific needs of resuscitation, C focuses on a different aspect of patient management, and D is not directly related to the resuscitation process.

Correct Answer: D

Rationale: The correct answer is D because X-ray of the chest and pelvis are important adjuncts in assessing trauma patients to rule out life-threatening injuries like pneumothorax, hemothorax, pelvic fractures, etc. This patient's mechanism of injury suggests the possibility of pelvic injury (Choice A is incorrect). While blood loss from the lower limbs could contribute to hypotension, other causes like internal bleeding should also be considered (Choice B is incorrect). Spinal cord injury is less likely to be the cause of hypotension in this case compared to hemorrhage or other traumatic injuries (Choice C is incorrect). In summary, obtaining X-rays of the chest and pelvis is crucial in the initial assessment of trauma patients to identify potentially life-threatening injuries.