Emergency Medicine Management of Trauma Patients: Review Questions David B. Levy, DO, FAAEM, FACEP Dr. Levy is an Associate Professor of Emergency Medicine, Temple University School of Medicine, and an Attending Physician, Temple University Hospital, Philadelphia, PA; and an Advanced Trauma Life Support Instructor. The “golden hour” is the critical period from time of injury to definitive care. Because of the anxiety that trauma provokes, it is essential that health care workers concerned with trauma commit to memory a systematic plan that is straightforward, logical, and easily reproducible. The following questions are based on the approach established by the American College of Surgeons in the Advanced Trauma Life Support Course. Choose the single best answer for each question.
	1. A 61-year-old woman, a front-seat restrained passenger, is brought to the emergency department (ED) by paramedics after a motor vehicle crash. Her vital signs in the field were as follows: blood pressure, 180/104 mm Hg; heart rate, 60 bpm; and respiratory rate, 10 breaths/min and irregular. She is nonverbal and unresponsive to painful stimuli. There are obvious head wounds. Which of the following is the most appropriate first step in her treatment? Secure the patient’s airway Obtain a lateral radiographic film of the cervical spine Lower the patient’s blood pressure Determine the patient’s Glasgow Coma Scale (GCS) score Order an immediate computed tomographic scan of the head Click here to compare your answer. 2. A 15-year-old boy is brought to the ED after sustaining a deep, actively bleeding, 9-cm laceration to his medial left thigh from a power saw. Which one of the following should be performed in the immediate management of the wound? Apply a tourniquet Apply direct pressure to the wound Apply a hemostat to bleeding blood vessels Provide fluid resuscitation to restore blood pressure to normotension prior to addressing the bleeding site Perform wound exploration and repair with vertical mattress sutures to tamponade bleeding Click here to compare your answer.		3. Paramedics transport to the ED a 44-year-old man, the victim of a single-car, front-end collision into a telephone pole. The medics found an empty fifth of vodka in the front seat of the car. The patient’s airway is clear, and his respiratory rate is 28 breaths/min, with equal but poor air entry (a diaphragmatic breathing pattern is noted). His other vital signs are as follows: blood pressure, 70/30 mm Hg; heart rate, 130 bpm and regular; and GCS score, 15. However, there is no movement below the C5 spinal level, and priapism is noted. Which one of the following types of shock is the patient most likely experiencing? Cardiogenic shock Distributive shock secondary to alcohol ingestion Hypovolemic shock Neurogenic shock Spinal shock Click here to compare your answer. 4. A 35-year-old woman is brought to the ED after receiving a stab wound to the right side of the chest at the third intercostal space in the midclavicular line. She is acutely dyspneic but can say her name. Her vital signs are as follows: blood pressure, 80/40 mm Hg; heart rate, 130 bpm; and respiratory rate, 60 breaths/min. Breath sounds are markedly diminished on the right side of the chest, neck veins are flat, and there is tracheal deviation to the left. Which of the following is the most appropriate first step in managing this patient’s injury? Order immediate radiography of the chest Obtain an arterial blood gas measurement Administer a bolus dose of lactated Ringer’s solution, intravenously Intubate the patient Perform needle decompression of the right pleural space Click here to compare your answer.
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