Trauma
Questions
124.A 58-year-old woman is brought to the emergency department (ED)
by emergency medical service (EMS) after slipping on a patch of ice while
walking to work and hitting her head on the cement pavement. Bystanders
acknowledged that the patient was unconscious for approximately 1 minute.
On arrival, her vital signs are: blood pressure (BP) 155/75 mm Hg, heart rate
(HR) 89 beats per minute, respiratory rate (RR) 18 breaths per minute, and
pulse oxygenation 98% on room air. She has a 5-cm laceration to the back
of her head that is actively bleeding. You ask the patient what happened
but she cannot remember. You inform her that she is in the hospital as a
result of a fall. Over the next 10 minutes she asks you repeatedly what
happened and where she is. You do not find any focal neurologic deficits.
As you bring the patient to the CT scanner she vomits once. CT results show
a normal brain scan. Which of the following is the most likely diagnosis?
a. Cerebral concussion
b. Diffuse axonal injury
c. Cerebral contusion
d. Posttraumatic epilepsy
e. Trauma-induced Alzheimer disease
125.A 41-year-old man, the restrained driver in a high-speed motor vehicle
collision, is brought to the ED by EMS. The patient is breathing without dif-
ficulty with bilateral and equal breaths sounds. He has strong pulses periph-
erally indicating a BP of at least 90 mm Hg. The HR is 121 beats per minute.
His Glasgow Coma Scale (GCS) is 14. A secondary survey reveals chest wall
bruising. You suspect a cardiac injury. Which of the following locations most
commonly involve cardiac contusions?
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle
e. Septum
129