You suspect your unconscious adult trauma patient may have increased intracranial pressure from a closed head injury. Due to the compression forces of increased intracranial pressure, at what level of brain injury would be expected if the patient is exhibiting Cheyne-Stokes respirations and is presenting with increasing blood pressure readings and a decreasing, reactive pulse rate?

Correct Answer: A

Rationale: The correct answer is A: Cortex and upper brainstem. When a patient with increased intracranial pressure exhibits Cheyne-Stokes respirations, increasing blood pressure, and decreasing, reactive pulse rate, it indicates dysfunction at the level of the cortex and upper brainstem. Cheyne-Stokes respirations are associated with damage at the level of the cortex. Increasing blood pressure and decreasing, reactive pulse rate are signs of raised intracranial pressure affecting the upper brainstem. Dysfunction at the midbrain region or lower portion of the brainstem would present with different symptoms, such as pinpoint pupils or abnormal posturing. The medulla oblongata is responsible for controlling vital functions like breathing and heart rate, so dysfunction in this region would present with more severe respiratory and cardiovascular symptoms.

Correct Answer: C

Rationale: The correct answer is C (19 to 23 centimeters) because the correct depth marking for an adult orotracheal intubation is typically at 21 to 23 centimeters at the teeth or 19 to 21 centimeters at the lips. Placing the tube 2 to 3 cm above the carina ensures adequate ventilation without the risk of the tube being too deep or too shallow. Choices A, B, and D are incorrect because they are outside the recommended depth range for adult orotracheal intubation, which can lead to complications such as inadequate ventilation, aspiration, or trauma to surrounding structures.

Correct Answer: C

Rationale: The correct answer is C because the patient experiencing a loss of consciousness immediately following the injury, regaining consciousness quickly, and then losing consciousness again is indicative of an epidural hematoma. This pattern is known as the "lucid interval," where the initial impact causes bleeding between the skull and dura mater, leading to a temporary improvement in symptoms before the hematoma expands, causing increased intracranial pressure and loss of consciousness. Choice A (Goose egg' noted on patient's head) is not specific to epidural hematoma and can occur in various head injuries. Choice B (The patient is unconscious when you arrive on the scene and remains that way throughout transport) is more indicative of a severe traumatic brain injury with continuous loss of consciousness rather than the characteristic pattern of an epidural hematoma. Choice D (Sudden, severe headache) is more commonly associated with subarachnoid hemorrhage or traumatic brain injury but not specifically with epidural hematoma.

Correct Answer: C

Rationale: The correct answer is C because inducing mild hypothermia in a post-arrest patient helps reduce intracranial pressure, cerebral metabolic rate, and the brain's demand for oxygen. This is crucial in preventing secondary brain injury and improving neurological outcomes. Choice A is incorrect because hypothermia does not reduce the body's need for stored energy (sugar), but actually can lead to metabolic changes that may increase the body's energy demand. Choice B is incorrect because while hypothermia may increase blood flow to the brain and heart, it also reduces blood flow to peripheral tissues, potentially causing harm to these areas. Choice D is incorrect because hypothermia does not reduce the amount of oxygen and blood circulation needed to supply the tissues of the periphery, and in fact, can lead to decreased tissue perfusion and oxygen delivery.

Correct Answer: D

Rationale: The correct answer is D: Admit the patient to the intensive care unit. This is the most appropriate management because the 8-year-old boy has suffered a significant fall resulting in a spleen laceration, indicating a severe injury. Admitting the patient to the ICU allows for close monitoring of his condition, ensuring immediate intervention if his condition deteriorates. Option A, Type and crossmatch for blood, is not the priority in this scenario as stabilizing the patient's condition takes precedence. Option B, requesting consultation of a pediatrician, may be necessary but not as urgent as admitting to the ICU. Option C, transferring the patient to a trauma center, may delay critical care that the patient needs immediately.