You are on-scene with a 55-year-old cardiac history patient who suddenly collapsed during dinner with his family. He is found to be pulseless and apneic with his family performing adequate CPR on arrival. His wife is distraught and hands you a legal DNR order signed by his physician. She states that he does not have a terminal illness and begs you to ignore the legal order and 'do everything in your capabilities to save him!' Which of the following would be most appropriate in this situation?

Correct Answer: D

Rationale: The correct answer is D: Initiate full resuscitation efforts including advanced cardiac life support, and contact medical control. In this scenario, the patient is found to be pulseless and apneic with CPR being performed by the family. The legal DNR order is not applicable in this situation as the patient does not have a terminal illness. Therefore, it is crucial to prioritize the patient's immediate need for resuscitation. Initiating full resuscitation efforts, including advanced cardiac life support, is necessary to maximize the chances of survival. Contacting medical control will ensure proper guidance and support during the resuscitation process. Choices A, B, and C are incorrect: A: Contacting medical control and waiting for approval before initiating full resuscitation could delay life-saving interventions. B: Stopping all resuscitation efforts based on the legal DNR order without considering the patient's current condition would be inappropriate. C: Advising the family to stop CPR and explaining the legal D

Correct Answer: C

Rationale: Correct Answer: C - Severe maxillofacial fractures Rationale: 1. Severe maxillofacial fractures can compromise the airway due to obstruction or displacement of structures. 2. Airway management is crucial in trauma patients to ensure adequate oxygenation and ventilation. 3. Maxillofacial fractures can lead to airway compromise rapidly, requiring a definitive airway intervention. 4. Other choices (A: Facial lacerations, B: Repeated vomiting, D: Sternal fracture) may not directly impact the airway to the same extent as severe maxillofacial fractures.

Correct Answer: C

Rationale: The correct answer is C: Hyperglycemia. In a multisystem injured patient, the primary causes of depressed consciousness are related to perfusion and oxygenation. Hyperglycemia, while a concern, is less likely to directly cause a depressed level of consciousness compared to shock, head injury, and impaired oxygenation. Hyperglycemia may lead to symptoms like confusion or weakness, but it typically does not result in a significant decrease in consciousness level. Therefore, in the context of a multisystem injured patient, hyperglycemia is the least likely cause of a depressed level of consciousness.

Correct Answer: B

Rationale: Correct Answer: B - Insert a definitive airway Rationale: 1. Patient has a low GCS of 8, indicating impaired consciousness and airway protection. 2. Obesity can further complicate airway management during sedation. 3. Inserting a definitive airway ensures adequate oxygenation and ventilation. 4. CT scan can cause respiratory depression, necessitating secure airway before transfer. 5. Multilumen esophageal airway is not indicated as it does not secure the airway. 6. Sedative drugs should be used cautiously due to the risk of respiratory depression. 7. Lateral cervical spine film is not necessary before CT scan in this scenario.

Correct Answer: C

Rationale: The correct answer is C: "FAST exam." In this scenario, the patient presents with signs of hypovolemic shock following a chest stab wound. The FAST exam (Focused Assessment with Sonography in Trauma) is crucial for rapid identification of intra-abdominal bleeding, which can occur concurrently with thoracic injuries. It is a quick and non-invasive bedside ultrasound assessment that can detect free fluid in the pericardial, pleural, and peritoneal spaces. Identifying intra-abdominal bleeding is important as it may require emergent surgical intervention to prevent further deterioration. Choice A, "CT scan of the chest," would take more time and is not the immediate priority in a hemodynamically unstable patient. Choice B, "12 lead ECG," is important in assessing for cardiac injury but is not the most critical step in this scenario. Choice D, "Begin infusion of RBCs," may be necessary later but addressing the source of bleeding and volume status through