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 because autonomic nervous system involvement in a spinal cord injury often results in bradycardia, hypotension, and a loss of sweating or shivering ability. This is due to disruption of sympathetic and parasympathetic pathways. Choice B is incorrect because hypertension and warm, dry skin are not typical signs of autonomic involvement in spinal cord injury. Choice C is incorrect because tachycardia and hypertension are more commonly seen with sympathetic overactivity, not autonomic involvement in spinal cord injury. Choice D is incorrect because tachycardia, hypotension, diaphoresis, and cool, clammy skin are more indicative of shock rather than specific autonomic involvement in spinal cord injury.

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.

Correct Answer: A

Rationale: The correct answer is A: "Gum elastic bougie." When the vocal cords are not visible during intubation, a bougie is valuable for navigating the airway and guiding the endotracheal tube. Step 1: Use the bougie to feel for the tracheal rings. Step 2: Advance bougie until resistance is felt. Step 3: Thread the endotracheal tube over the bougie. Step 4: Remove the bougie. The other choices are incorrect because B (x-ray) does not directly aid in intubation, C (nasopharyngeal airway) is not useful when vocal cords are not visible, and D (oxygen) is important but not a tool for intubation.