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: Step 1: Cheyne-Stokes respirations suggest dysfunction in the cerebral cortex and upper brainstem. Step 2: Increasing blood pressure and decreasing, reactive pulse rate indicate a raised intracranial pressure affecting the cortex and upper brainstem. Step 3: Compression in the cortex and upper brainstem can lead to autonomic dysregulation causing the observed symptoms. Step 4: Midbrain, medulla oblongata, and lower brainstem are not directly associated with the symptoms described. Summary: The correct answer is A because the symptoms presented are indicative of dysfunction in the cortex and upper brainstem, while the other choices do not align with the specific symptoms observed in the patient.

Correct Answer: C

Rationale: The correct answer is C (19 to 23 centimeters). The proper depth marking for an orotracheal intubation in an average-sized adult is typically around 21 centimeters at the teeth for females and 23 centimeters for males. This positioning ensures that the tip of the endotracheal tube is approximately 2 to 3 cm above the carina, allowing for adequate ventilation while minimizing the risk of complications such as mainstem bronchus intubation. Choices A, B, and D are incorrect as they do not fall within the appropriate depth range for proper positioning of the endotracheal tube. Option A is too shallow, option B is too deep, and option D is also too deep and carries a risk of complications.

Correct Answer: C

Rationale: The correct answer is C because the patient lost consciousness immediately following the injury, then quickly regained consciousness, but lost consciousness again just before calling 911. This pattern of lucid intervals followed by a deteriorating level of consciousness is indicative of an epidural hematoma. The initial loss of consciousness is due to the initial trauma causing bleeding between the skull and the dura mater, leading to increased intracranial pressure. The temporary regaining of consciousness occurs when the hematoma temporarily stops expanding before resuming bleeding, causing a decline in consciousness again. Summary: A: A 'goose egg' noted on the patient's head is more indicative of a scalp hematoma or soft tissue injury, not necessarily an epidural hematoma. B: The patient being unconscious throughout transport could indicate a severe brain injury, but the specific pattern described in option C is more characteristic of an epidural hematoma. D: A sudden, severe headache may be a symptom of various head injuries, but it is

Correct Answer: C

Rationale: The correct answer is C because inducing mild hypothermia in a post-arrest patient with a return of spontaneous circulation 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. Explanation: 1. Reduced intracranial pressure: Hypothermia causes vasoconstriction, reducing cerebral blood flow and lowering intracranial pressure. 2. Decreased cerebral metabolic rate: Hypothermia slows down cellular metabolism, decreasing the brain's oxygen and energy requirements. 3. Lowered brain's demand for oxygen: With reduced metabolic rate and blood flow, the brain requires less oxygen. Summary of other choices: A: Hypothermia does not directly reduce the body's need for stored energy (sugar) but rather decreases metabolic rate. B: Hypothermia may alter blood flow distribution but does not specifically increase blood flow to the brain and heart. D: Hypothermia primarily affects the

Correct Answer: D

Rationale: The correct answer is D: Admit the patient to the intensive care unit. This is the most appropriate management because an 8-year-old boy with a spleen laceration after falling from a height needs close monitoring and potential interventions that can be provided in an intensive care setting. Admission to the ICU allows for continuous monitoring of vital signs, blood loss, and potential complications. Type and crossmatch for blood (A) may be necessary but is not the most urgent step in this scenario. Requesting consultation of a pediatrician (B) can be done after initial stabilization, and transferring the patient to a trauma center (C) may delay necessary interventions that can be provided in the current setting.