You are called to assist a 44-year-old male who was struck in the head with a large socket wrench at work. On arrival, the patient is conscious but confused; he complains he developed a sudden-onset severe headache moments after a wrench slipped off under pressure striking him in the temporal region of the skull. Co-workers state he was unconscious with abnormal posturing for about three minutes prior to EMS arrival. He states the headache went from the worst headache of his life to a dull throbbing headache and new-onset dizziness and nausea. His pupils are unequal with the right eye sluggish to respond while his grips remain equal but weak. As you continue your evaluation, he suddenly develops projectile vomiting and loses consciousness. Which of the following injuries is most likely to cause his presentation?

Correct Answer: B

Rationale: The correct answer is B: Epidural hematoma. In this case, the patient experienced a history of head trauma with a lucid interval followed by a rapid deterioration of symptoms, including severe headache, dizziness, nausea, unequal pupil response, weakness, and vomiting leading to unconsciousness. These signs are indicative of an epidural hematoma, which is typically caused by arterial bleeding between the dura mater and the skull following a traumatic head injury. The classic presentation of a lucid interval followed by a rapid decline in neurological status is a key feature of epidural hematoma. Now, let's analyze why the other choices are incorrect: A: Subdural hematoma - Typically presents with a slower onset of symptoms and is more common in elderly patients or those with a history of alcohol abuse. C: Subarachnoid hematoma - Usually presents with a sudden severe headache, often described as a thunderclap headache, and is associated with a history of sudden exertion or str

Correct Answer: A

Rationale: The correct answer is A: "Aggressive fluid infusion." In this scenario, the electrician likely suffered electrical burns leading to muscle breakdown and subsequent release of myoglobin into the bloodstream, causing renal damage. Aggressive fluid infusion helps prevent myoglobin-induced acute kidney injury by maintaining high urine output to flush out myoglobin. This initial management is crucial to prevent further kidney damage. Choice B: "Intravenous pyelography" is incorrect as it is a diagnostic imaging test for the urinary system, not a treatment for acute kidney injury. Choice C: "Debridement of necrotic muscle" is not the immediate priority and can be considered later if necessary. Choice D: "Admission to the ICU for observation" is not sufficient as immediate intervention is needed to prevent renal damage.

Correct Answer: D

Rationale: The correct answer is D: Tachycardia. When a patient experiences hemorrhage of 20% of blood volume, the body compensates by increasing heart rate to maintain adequate blood flow and oxygen delivery. Tachycardia is a common physiological response to hemorrhage. Oliguria (A) is reduced urine output, which may occur with severe dehydration but not specifically with hemorrhage. Confusion (B) is more likely to occur with severe hypovolemic shock rather than with a 20% blood loss. Hypotension (C) typically occurs with more significant blood loss, around 30% or more. Tachycardia is the earliest and most sensitive indicator of hemorrhage.

Correct Answer: D

Rationale: The correct answer is D because the absence of a palpable prostate on rectal exam is not a direct indicator of urethral injury. A: "Scrotal hematoma" suggests trauma to the genital area. B: Blood in rectal lumen indicates possible urethral or bladder injury. C: Blood in external urethral meatus suggests urethral injury with blood present at the urethral opening. Therefore, D is the only choice that does not directly relate to urethral injury.

Correct Answer: B

Rationale: The correct answer is B: 2L of iv crystalloid and vasopressors if BP does not respond. In this scenario, the patient is likely experiencing spinal shock leading to neurogenic shock, causing hypotension. Initial management should focus on fluid resuscitation with crystalloids to address hypovolemia. If the blood pressure does not respond to fluid resuscitation, vasopressors should be initiated to maintain perfusion. Choice A does not address the potential neurogenic shock, and giving blood transfusions without evidence of active bleeding is not indicated. Choice C with mannitol and steroids is not appropriate for this patient. Choice D with laparotomy is not indicated as there are no signs of abdominal trauma.