Your adult female postpartum patient delivered her newborn with the assistance of her husband five minutes prior to your arrival on the scene. The infant's Apgar score is 10, and the baby seems to be fine. However, the mother continues to bleed heavily after an adequate fundal massage and encouraging the infant to breastfeed. Her current heart rate is 125 bpm; her blood pressure is 108/60, and she is breathing 22 times a minute with an SpO2 of 97. After ensuring a second infant is not present, which of the following interventions would medical command most likely recommend?

Correct Answer: D

Rationale: The correct answer is D because administering oxytocin infusion is the most appropriate intervention for postpartum hemorrhage due to uterine atony, which is a common cause of excessive bleeding after delivery. Oxytocin helps to stimulate uterine contractions, which will help control the bleeding by reducing the size of the blood vessels at the placental site. This intervention is evidence-based and recommended in postpartum hemorrhage management protocols. Other choices are incorrect because: A: Packing the vagina is not indicated unless there is active vaginal bleeding that cannot be controlled by other methods. B: Administering lactated Ringer's solution at a rapid rate is not the first-line treatment for postpartum hemorrhage. C: Trendelenburg position and a fluid bolus of normal saline are not recommended as they can increase the risk of fluid overload and do not address the underlying cause of the bleeding. In summary, administering oxytocin infusion is the most appropriate intervention to manage post

Correct Answer: C

Rationale: The correct answer is C: An advanced directive. This legal document allows an individual to specify their preferences for medical treatments in case they are unable to make decisions. It includes instructions on what treatments to receive or avoid. A DNR order (choice A) specifically pertains to resuscitation preferences only. A will (choice B) outlines the distribution of assets after death, not medical care decisions. Personal directive (choice D) is not a commonly used term for this type of legal document.

Correct Answer: C

Rationale: The correct answer is C: Control internal hemorrhage operatively. In cases of gunshot wounds to the abdomen, the priority is to control internal bleeding through surgical intervention. This is crucial to prevent hypovolemic shock and potential complications. Administering O-negative blood (choice A) is important for resuscitation but is not the definitive treatment. Applying external warming devices (choice B) is not the primary concern in this scenario. Using a pneumatic antishock garment (PASG) (choice D) may be used in some cases but is not the definitive treatment for managing internal hemorrhage. Operating to control the bleeding is essential for the patient's survival.

Correct Answer: D

Rationale: The correct answer is D: Endotracheal intubation and mechanical ventilation. In the case of a flail chest, where multiple ribs are fractured causing a segment of the chest wall to move independently from the rest of the thorax, the patient is at high risk of respiratory compromise. Endotracheal intubation and mechanical ventilation are necessary to ensure adequate oxygenation and ventilation, as the flail segment impairs the ability of the chest wall to expand effectively. High-flow oxygen via a nonrebreathing mask alone may not be sufficient to support the patient's respiratory needs. Choice A is incorrect because the patient's confusion is likely due to inadequate oxygenation and ventilation, not fluid resuscitation. Choice B is incorrect because cyanosis is a late sign of respiratory distress and should not be solely relied upon for management decisions. Choice C is incorrect as tachypnea is a compensatory mechanism and not a definitive management strategy for a flail chest.

Correct Answer: D

Rationale: The correct answer is D - Less brain contusions. The scenario described suggests a rapid deterioration in neurological status after an initial period of lucidity, indicating the possibility of a traumatic brain injury. The presence of a large left pupil suggests uncal herniation, which can be due to increased intracranial pressure from brain contusions. The sudden decline in GCS from 15 to 6 further supports this. The lack of focal neurological signs like flail chest or pulmonary contusion makes choices A and C less likely. Choice B is unrelated to the scenario provided. Therefore, the most likely explanation for the patient's worsening condition is the development of brain contusions leading to increased intracranial pressure and subsequent herniation.