You are treating and transporting a 26-year-old female involved in an MVA. She has multiple injuries, but all associated hemorrhage is controlled. The patient is exhibiting signs and symptoms of hypovolemic shock. During treatment and transport, you infuse one liter of lactated Ringer's solution, and the patient remains hypotensive. Once at the hospital, which of the following is most likely to be administered immediately upon arrival?

Correct Answer: B

Rationale: The correct answer is B: O-negative packed red blood cells. In hypovolemic shock, the primary issue is a significant loss of red blood cells leading to decreased oxygen-carrying capacity and subsequent hypotension. Packed red blood cells contain a concentrated amount of red blood cells, which can help improve the patient's oxygenation status and hemodynamic stability more effectively than whole blood or other blood products. O-negative blood is used to avoid potential reactions due to ABO incompatibility. Administering packed red blood cells upon arrival at the hospital is crucial to rapidly address the underlying cause of hypovolemic shock. Choices A, C, and D are incorrect because whole blood or packed red blood cells without plasma may not provide the necessary oxygen-carrying capacity to address the patient's condition effectively. Additionally, using O-positive blood products for a female patient can lead to potentially harmful reactions due to ABO incompatibility.

Correct Answer: D

Rationale: The correct answer is D: Presence of deep tendon reflexes. This finding indicates intact neurological function and rules out spinal cord injury as the cause of hypotension. Spinal cord injury typically results in loss of deep tendon reflexes. Prispism (choice A) is a painful erection, which is not directly related to hypotension. Bradycardia (choice B) indicates a slow heart rate but does not specifically suggest a cause of hypotension. Diaphragmatic breathing (choice C) is a breathing pattern that may occur in various conditions but does not directly point to a specific cause of hypotension.

Correct Answer: D

Rationale: The correct answer is D: Hemorrhage into the chest or abdomen. In this scenario, the man's profound shock without open wounds or fractures suggests internal bleeding, likely from hemorrhage into the chest or abdomen. This type of bleeding can lead to rapid blood loss and shock. Subdural and epidural hematomas involve bleeding in the brain, not the cause of shock in this case. A transected lumbar spinal cord may cause neurological deficits but is less likely to lead to profound shock without external injuries. Hemorrhage into the chest or abdomen is the most likely cause of shock in a trauma patient without external signs of bleeding.

Correct Answer: C

Rationale: The correct answer is C: Blood transfusion can be delivered through an intraosseous access. In pediatric resuscitation, intraosseous access is commonly used for rapid vascular access when peripheral IV access is difficult. This route allows for the delivery of fluids, medications, and even blood products such as transfusions. It is a reliable and effective alternative in emergency situations. Explanation for why other choices are incorrect: A: "Intraosseous access should only be considered after five percutaneous attempts" - This statement is incorrect as intraosseous access is often the preferred route in pediatric resuscitation when peripheral IV access is difficult. B: Cut down at the ankle is a preferred initial access technique - This statement is incorrect as intraosseous access is typically preferred over cut down procedures in pediatric resuscitation. D: Internal jugular cannulation is the next preferred option when percutaneous venous access fails - This statement is incorrect as intraosseous

Correct Answer: C

Rationale: The correct answer is C: Be treated for hypovolemic shock. Rationale: 1. The patient's low blood pressure (60/40) and high pulse rate (140 bpm) indicate hypovolemic shock due to significant blood loss from the crash. 2. Treatment for hypovolemic shock involves restoring intravascular volume with intravenous fluids to improve perfusion and stabilize the patient's condition. 3. Initiating treatment for hypovolemic shock is crucial to prevent further complications and improve the patient's chances of survival. Summary: - Choice A (Undergo exploratory celiotomy) is incorrect as it involves abdominal surgery and is not indicated based on the presented symptoms. - Choice B (Be treated for neurogenic shock) is incorrect as the symptoms are more indicative of hypovolemic shock. - Choice D (Undergo immediate nasotracheal intubation) is incorrect as airway management is not the primary concern in this scenario, addressing hypov