Your adult trauma patient has a potential internal injury allowing bleeding into the thoracic cavity. As a general rule, where should the patient's mean arterial pressure (MAP) be maintained while treating and transporting the patient to the hospital?

Correct Answer: D

Rationale: The correct answer is D: MAP of 60 mmHg to 65 mmHg. This range ensures perfusion to vital organs while balancing the risk of exacerbating bleeding. A MAP below 60 mmHg may compromise organ perfusion, leading to further injury. Choice A (MAP of 50-55 mmHg) is too low and may result in inadequate perfusion. Choice B (MAP of 35-40 mmHg) is dangerously low, risking organ failure. Choice C (MAP of 85-90 mmHg) is too high, potentially increasing bleeding in the thoracic cavity. Maintaining a MAP of 60-65 mmHg is the optimal balance for this trauma patient.

Correct Answer: C

Rationale: Step-by-step rationale for why choice C is correct: 1. A cross-table lateral x-ray of the cervical spine is crucial for evaluating cervical spine injuries. 2. It allows visualization of all 7 cervical vertebrae and the C-7 to T-1 relationship. 3. This comprehensive view helps in identifying any fractures or dislocations accurately. 4. Missing any part of the cervical spine can lead to overlooking potential injuries. 5. Therefore, ensuring visualization of all 7 vertebrae and the C-7 to T-1 relationship is essential for an accurate assessment. Summary of why other choices are incorrect: - Choice A is incorrect because obtaining the x-ray does not necessarily have to precede endotracheal intubation. - Choice B is incorrect because a cross-table lateral x-ray does not always exclude serious cervical spine injuries; it helps in identifying them. - Choice D is incorrect because even unconscious patients with penetrating cervical injuries may require a cross-table lateral x-ray for accurate

Correct Answer: D

Rationale: The correct answer is D because needle-impenetrable sterile gloves are not minimal precautions for preventing the spread of communicable diseases during resuscitation. Goggles, face mask, and water-impervious gown are necessary to protect against bodily fluids, but needle-impenetrable gloves are not typically required unless there is a specific risk of needlestick injuries. Choosing D would be overkill for minimal precautions.

Correct Answer: C

Rationale: The correct answer is C: Increased cardiac output. Neurogenic shock is characterized by decreased cardiac output due to loss of sympathetic tone. Increased venous capacitance (A) and decreased systemic vascular resistance (B) are features of neurogenic shock due to vasodilation. Warm skin (D) is due to peripheral vasodilation. Therefore, increased cardiac output (C) is not a feature of neurogenic shock.

Correct Answer: A

Rationale: The correct answer is A: Hemothorax. The clinical presentation of a 30-year-old male with shortness of breath, tachycardia, hypotension, diminished air entry, and dullness on percussion following a stab wound to the chest is most indicative of hemothorax. Hemothorax is the accumulation of blood in the pleural space, leading to respiratory compromise and hemodynamic instability. The diminished air entry and dullness on percussion suggest the presence of blood in the pleural cavity, causing lung collapse. The absence of distended neck veins rules out pericardial tamponade. The absence of tracheal deviation and mediastinal shift rules out tension pneumothorax. Hypovolemia from a liver injury would not explain the localized findings in the chest. Therefore, hemothorax is the most likely diagnosis in this scenario.