You are on scene at a motor vehicle accident, and your 20-year-old patient is entrapped. He is unconscious, unresponsive, and has a palpable carotid pulse that is weak and thready. His breathing is slow and shallow at four times a minute with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. Fire department on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped patient. However, access is limited to the seated patient, and extrication is expected to take another twenty minutes. After having your partner maintain cervical spine stabilization, which of the following would be the best choice for securing the patient's airway?

Correct Answer: C

Rationale: The correct answer is C: Intubate the patient using the blind orotracheal intubation technique to maintain in-line mobilization of the spine, then assist ventilation. In this scenario, the patient is entrapped with limited access and expected extrication time of 20 minutes. Given the patient's unconsciousness, unresponsiveness, weak carotid pulse, and slow, shallow breathing, securing the airway is crucial to ensure adequate oxygenation and ventilation. Intubating the patient using the blind orotracheal technique allows for maintaining in-line mobilization of the spine, reducing the risk of further spinal injury during the extrication process. This approach provides a more definitive airway management compared to nasal airway insertion or bag-valve mask ventilation. Nasotracheal intubation (choice B) may not be feasible due to limited access and potential for further injury. Using a King LTD (choice D) is not recommended in this situation as it does not provide the same

Correct Answer: D

Rationale: The correct answer is D: To help lower dangerous potassium levels. High-dose nebulized albuterol is recommended for hyperkalemic patients because it activates beta-2 adrenergic receptors, leading to an intracellular shift of potassium, thereby decreasing serum potassium levels. Albuterol does not directly address ventilatory status (choice A), metabolic acidosis (choice B), or increase available calcium at the cellular level (choice C). It is essential to focus on treating the underlying cause of hyperkalemia, which is the dangerously high potassium levels in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Milfeasance. Negligence is divided into three categories: malfeasance (performing an act that is wrongful), misfeasance (performing a lawful act in a wrongful manner), and nonfeasance (failing to perform a required duty). "Milfeasance" is not a recognized term in negligence law and does not fit into any of the established categories. Therefore, it is not a valid category of negligence. Malfeasance, misfeasance, and nonfeasance are the only recognized categories in negligence law.

Correct Answer: C

Rationale: The correct answer is C: Central cord syndrome. This syndrome is typically caused by hyperextension injuries in older individuals, resulting in motor weakness and sensory loss, often more pronounced in the upper extremities. In this case, the man's prolonged unconsciousness and lack of lower extremity movement fit the clinical presentation of central cord syndrome due to the mechanism of injury. The other choices are less likely as an epidural hematoma would present with focal neurological deficits, a pelvic fracture with lower extremity symptoms but not unconsciousness, and intracerebral hemorrhage with altered mental status and focal neurological deficits.

Correct Answer: D

Rationale: The correct answer is D, a patient with a severe cardiac contusion. Central venous pressure monitoring is essential for assessing fluid status and cardiac function in patients with significant cardiac injuries. Monitoring CVP can guide fluid resuscitation and help optimize cardiac output in these patients. Choice A, a patient with a splenic laceration, does not typically require CVP monitoring as the focus is on managing bleeding and hemodynamic stability. Choice B, a patient with an inhalation injury, would benefit more from oxygenation monitoring and respiratory support rather than CVP monitoring. Choice C, a 6-year-old child with a pelvic fracture, may require monitoring for hypovolemic shock but not necessarily through CVP monitoring, which is more invasive and not typically indicated in this scenario.