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: Administer oxytocin infusion at 20 to 30 gtts/min depending on bleeding severity. Oxytocin is a uterotonic agent that helps control postpartum hemorrhage by causing uterine contractions, which can help stop the bleeding. In this scenario, the mother is experiencing postpartum hemorrhage despite initial interventions. Administering oxytocin can help control the bleeding and prevent further complications. Choice A is incorrect because packing the vagina with pads is not the recommended first-line treatment for postpartum hemorrhage. Choice B is incorrect because administering lactated Ringer's solution under pressure is not the appropriate intervention for postpartum hemorrhage. Choice C is incorrect because Trendelenburg position is not recommended for managing postpartum hemorrhage and can potentially worsen the situation by increasing blood flow to the head.

Correct Answer: C

Rationale: The correct answer is C: An advanced directive. An advanced directive is a legal document that allows an individual to specify their medical treatment preferences in case they are unable to make decisions. It includes instructions on the use of life-sustaining treatments. A: A do not resuscitate order (DNR) specifically addresses whether or not to perform cardiopulmonary resuscitation in case of cardiac arrest, but it does not cover overall medical treatment preferences. B: A will is a legal document that specifies how a person's assets and properties should be distributed after their death, not their medical treatment preferences. D: A personal directive is a general term that may refer to various legal documents but does not specifically address medical treatment preferences.

Correct Answer: C

Rationale: The correct answer is C: Control internal hemorrhage operatively. In managing a gunshot wound to the abdomen, the priority is to control internal bleeding, usually through surgical intervention. Administering O-negative blood (A) is important for resuscitation but does not address the primary issue. External warming devices (B) are not the priority in this scenario. Applying a pneumatic antishock garment (PASG) (D) is not recommended as it could delay necessary surgical intervention to control hemorrhage. Operating to control internal hemorrhage is crucial to prevent further blood loss and stabilize the patient's condition.

Correct Answer: D

Rationale: The correct answer is D because in a patient with flail chest, which is a serious condition involving multiple rib fractures leading to paradoxical chest wall movement, mechanical ventilation is essential to support adequate ventilation and oxygenation. Endotracheal intubation helps secure the airway and allows for positive pressure ventilation to improve gas exchange. This is crucial in preventing respiratory failure and ensuring adequate oxygen delivery to tissues. Choice A is incorrect as confusion is not an indication for Ringers lactate solution. Choice B, cyanosis, does not address the need for ventilatory support in flail chest. Choice C, tachypnea, is a symptom of respiratory distress but does not address the need for mechanical ventilation, which is the definitive management for flail chest.

Correct Answer: D

Rationale: The correct answer is D, less brain contusions. The scenario describes a traumatic brain injury likely due to the fall. The initial GCS of 15 indicates mild TBI, which deteriorated rapidly to GCS 6 and a large left pupil, suggesting brain herniation. The sudden decline in neurological status, particularly with a focal sign like a dilated pupil, is more indicative of diffuse axonal injury (DAI) or brain herniation rather than epidural hematoma or pulmonary contusion. The absence of any mention of focal neurological deficits or direct trauma to the chest makes choices A and C less likely. Choice B is unrelated to the scenario.