You are working in a pre-hospital setting and are called for a 40-year-old male who was the victim of a stabbing. The patient has a blood pressure of 87/50 and a heart rate of 130. There is a large amount of blood on the scene. After applying direct pressure to the wound on the patient's arm and stopping the bleeding, of the following what would be the best intervention to mitigate the patient's blood pressure?

Correct Answer: D

Rationale: Correct Answer: D Rationale: Establishing an IV and administering fluid to keep the patient's BP at or near 90 systolic is the best intervention. This approach aims to increase the patient's blood volume, improve tissue perfusion, and support vital organ function. The goal is to stabilize the patient's blood pressure within a safe range to prevent further complications. This approach is a standard practice in managing hypotension due to hemorrhage. Summary: A: Administering 2 liters of fluid may be excessive and could lead to fluid overload in this scenario. B: Norepinephrine is a vasopressor and should only be considered if fluid resuscitation fails to improve the patient's blood pressure. C: Dopamine is also a vasopressor and is typically used in more severe cases of hypotension. It is not the first-line intervention in this scenario.

Correct Answer: D

Rationale: The correct answer is D, percutaneous peripheral veins in the upper extremities. In a 6-year-old boy, the preferred route of venous access is peripheral veins in the upper extremities because they are easily accessible and have lower complication rates compared to other options. This route allows for rapid administration of fluids and medications in emergency situations. Percutaneous femoral vein cannulation (A) may be more invasive and carries a higher risk of complications. Cutdown on the saphenous vein at the ankle (B) is not ideal due to its location and potential difficulty in accessing. Intraosseous catheter placement in the proximal tibia (C) is a viable option but may be more invasive and time-consuming compared to peripheral veins in the upper extremities.

Correct Answer: C

Rationale: The correct answer is C because visualization of all 7 cervical vertebrae and the C7 to T1 relationship is essential for proper evaluation of the cervical spine on a cross-table lateral x-ray. This allows for assessment of alignment, fractures, dislocations, and potential injuries. Option A is incorrect as the x-ray does not need to precede endotracheal intubation. Option B is incorrect as serious cervical spine injuries can still be present even if not initially seen on the x-ray. Option D is incorrect because unconscious patients with penetrating cervical injuries may still benefit from a cross-table lateral x-ray to assess for additional injuries.

Correct Answer: D

Rationale: The correct answer is D, "Needle-impenetrable sterile gloves," as they are not considered minimal precautions for preventing the spread of communicable diseases during resuscitation. Here's the rationale: 1. Goggles, face masks, and water-impervious gowns are essential to prevent contact with bodily fluids and airborne pathogens during resuscitation. 2. Needle-impenetrable sterile gloves are not typically required for basic resuscitation procedures and are not considered a minimal precaution. 3. Standard sterile gloves provide adequate protection against contact with blood and other bodily fluids in most resuscitation scenarios. 4. Using needle-impenetrable gloves for all resuscitation situations would be excessive and unnecessary.

Correct Answer: C

Rationale: The correct answer is C: Increased cardiac output. Neurogenic shock is characterized by decreased cardiac output due to disruption of sympathetic nervous system input to the heart. A is incorrect as neurogenic shock leads to decreased venous capacitance, not increased. B is incorrect as it is a feature of neurogenic shock, causing decreased systemic vascular resistance. D is incorrect as neurogenic shock typically presents with cold and clammy skin due to decreased sympathetic tone.