You are evaluating a trauma patient who may have sustained a spinal cord injury. Which of the following would you expect to see in a trauma patient with a spinal cord injury with autonomic nervous system involvement?

Correct Answer: A

Rationale: The correct answer is A. In spinal cord injury with autonomic nervous system involvement, there is disruption of sympathetic and parasympathetic control. This leads to bradycardia due to loss of sympathetic tone, hypotension due to disrupted baroreceptor reflexes, and loss of sweating or shivering ability due to impaired temperature regulation. Choice B is incorrect because hypertension and warm, dry skin are more indicative of sympathetic overactivity, not autonomic dysfunction. Numbness of fingertips is not a typical feature of autonomic involvement. Choice C is incorrect as tachycardia and hypertension are more suggestive of sympathetic overactivity, and one-sided paralysis and amnesia are not specific to autonomic dysfunction. Choice D is incorrect as tachycardia and diaphoresis suggest sympathetic overactivity, while cool and clammy skin is more indicative of hypovolemia rather than autonomic dysfunction.

Correct Answer: B

Rationale: Correct Answer: B (Tamponade of the wound with a pressure dressing) Rationale: 1. Tamponade prevents further bleeding and reduces the risk of hypovolemic shock. 2. Pressure dressing helps control bleeding and reduces the risk of infection. 3. Stabilizing the wound is crucial before further intervention. 4. Angiography, wound exploration, and realignment are not immediate priorities.

Correct Answer: A

Rationale: The correct initial step in managing a head-injury patient is to secure the airway (Choice A). This is crucial for ensuring adequate oxygenation and ventilation. Without a patent airway, the patient may suffer from hypoxia, leading to further brain injury. Obtaining c-spine film (Choice B) is important but not the most immediate concern. Supporting circulation (Choice C) is vital but comes after ensuring airway patency. Controlling scalp hemorrhage (Choice D) is also important but does not take precedence over securing the airway in the initial management of a head-injury patient.

Correct Answer: C

Rationale: Step 1: The scenario describes a man pinned by a cement truck with deformities and swelling in both thighs, indicating significant trauma. Step 2: The absence of open wounds suggests internal bleeding as the cause of shock. Step 3: Bilateral femoral fractures can lead to significant blood loss, resulting in shock. Step 4: Therefore, the shock is consistent with blood loss from bilateral femoral fractures, making choice C the correct answer. Step 5: The other choices are incorrect because shock in this case is more likely due to internal bleeding rather than pelvic fracture (A), fixed percentage blood loss (B), or traction splints (D).

Correct Answer: A

Rationale: The correct answer is A: "Gum elastic bougie." In difficult intubation situations where vocal cords are not visible, a bougie is essential. Step 1: Insert the bougie into the trachea until resistance is felt. Step 2: Advance the endotracheal tube over the bougie. Step 3: Remove the bougie. This technique helps guide the endotracheal tube into the trachea successfully. The other choices are incorrect. B: Lateral cervical spine x-ray is not useful for intubation. C: Nasopharyngeal airway is for maintaining airway patency, not for intubation. D: Oxygen does not aid in intubation directly.