You are preparing to intubate an apneic patient and decide to use a Macintosh blade. When using a curved blade on an adult, where should the tip of the laryngoscope blade be placed?

Correct Answer: C

Rationale: The correct answer is C: Directly into the vallecula. Placing the tip of the Macintosh blade directly into the vallecula helps lift the epiglottis and provides a clear view of the vocal cords during intubation. Placing it under the epiglottis (choice A) may obstruct the view. Placing it below the vallecula (choice B) may not provide adequate elevation. Placing it directly on the epiglottis (choice D) may cause trauma and difficulty in visualizing the glottis.

Correct Answer: C

Rationale: The correct answer is C: Breath sounds. In cardiac tamponade, there may be muffled heart sounds and distant or absent breath sounds due to the accumulation of fluid around the heart, compressing the lungs. This differentiates it from tension pneumothorax, where there is hyperresonance to percussion and decreased or absent breath sounds on the affected side. A: Tachycardia is a common feature of both cardiac tamponade and tension pneumothorax, so it does not differentiate between the two conditions. B: Pulse volume may be decreased in both cardiac tamponade and tension pneumothorax, so it is not the best differentiator. D: Pulse pressure may be narrowed in both conditions, so it is not the most specific differentiating factor.

Correct Answer: D

Rationale: Performing lower extremity fasciotomies is the correct choice in this scenario because the prolonged entrapment of the leg can lead to compartment syndrome, a condition where increased pressure within the muscles compromises blood flow, risking limb loss. Fasciotomies involve making incisions to release the pressure and restore circulation, thus improving chances of limb salvage. Applying skeletal traction (A) may help stabilize the leg but won't address the underlying issue of compromised blood flow. Administering anticoagulant drugs (B) is not directly relevant to the treatment of compartment syndrome. Administering thrombolytic therapy (C) is used for dissolving blood clots and is not indicated in this case.

Correct Answer: D

Rationale: The correct answer is D: Presence of hemotympanum. Hemotympanum is a significant finding that suggests a basilar skull fracture, which can lead to intracranial injury. CT is indicated to assess for potential brain injury in this case, despite the patient's initial normal vital signs and GCS score. A: Blood alcohol concentration is not an indication for CT in this scenario unless it affects the patient's mental status. B: An isolated scalp laceration does not necessarily indicate a need for CT unless there is suspicion of underlying skull fracture. C: A mandibular fracture is not directly related to the need for CT in this case, as it primarily affects the facial bones.

Correct Answer: A

Rationale: The correct answer is A because initial resuscitation in adult patients should start with 1-2L of crystalloid to restore intravascular volume. This helps improve tissue perfusion and oxygen delivery. Monitoring the patient's response (B) is important but not the initial step. Using crystalloid to normalize BP (C) may lead to fluid overload. Permissive hypotension in patients with head injury (D) is contraindicated as it can worsen cerebral perfusion.