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 curved Macintosh blade directly into the vallecula allows for optimal visualization of the glottis during intubation. By lifting the epiglottis indirectly, the blade creates space for passage of the endotracheal tube. Placing the blade directly under the epiglottis (A) may obstruct the view. Placing it in the space below the vallecula (B) may not provide sufficient elevation. Placing the blade directly on the epiglottis (D) can cause trauma and obstruct the view.

Correct Answer: C

Rationale: The correct answer is C: Breath sounds. In cardiac tamponade, there may be muffled or distant heart sounds due to the accumulation of fluid around the heart, impacting its ability to pump effectively. In tension pneumothorax, breath sounds may be absent or decreased on the affected side due to lung collapse. This differentiation is important as cardiac tamponade requires emergent pericardiocentesis, while tension pneumothorax necessitates needle decompression. Choices A, B, and D are not as useful in differentiating between the two conditions. Tachycardia may be present in both conditions, pulse volume may be decreased in both, and pulse pressure may be narrowed in both due to decreased cardiac output. Breath sounds are a key differentiating factor in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Performing lower extremity fasciotomies. In this scenario, the man's leg was trapped under the car for a prolonged period, leading to potential compartment syndrome. Fasciotomies can release pressure in the compartments, improving blood flow and potentially salvaging the limb. A: Applying skeletal traction may help stabilize the leg, but it does not address the underlying compartment syndrome. B: Administering anticoagulant drugs is not indicated for compartment syndrome and may increase the risk of bleeding. C: Administering thrombolytic therapy is not appropriate for compartment syndrome and may lead to further complications. In summary, lower extremity fasciotomies are the most appropriate intervention to improve chances for limb salvage in this case.

Correct Answer: D

Rationale: The correct answer is D: Presence of hemotympanum. Hemotympanum is indicative of a basilar skull fracture, which can lead to intracranial bleeding and brain injury. CT scan is necessary to evaluate for intracranial injuries in this case. A: Blood alcohol concentration is not an indication for CT in this scenario. B: A scalp laceration alone does not warrant a CT scan for traumatic brain injury. C: Mandibular fracture does not directly indicate traumatic brain injury and is not a reason for CT in this case.

Correct Answer: A

Rationale: The correct answer is A because initial resuscitation in adult patients should focus on restoring intravascular volume, which is effectively achieved with 1-2L of crystalloid fluids. This helps improve tissue perfusion and overall hemodynamics. Monitoring the patient's response (choice B) is important but secondary to the immediate need for volume replacement. Using crystalloid to normalize blood pressure (choice C) is not recommended as the sole goal, as other factors like tissue perfusion also need to be considered. Permissive hypotension (choice D) is contraindicated in patients with head injury as it can worsen brain perfusion.