128.Paramedics bring a 45-year-old man to the ED after being involved in
a high-speed motor vehicle collision. His BP is 85/50 mm Hg and HR is
131 beats per minute after administering 2 L of normal saline. He is awake
but slow in responding to questions. A right upper quadrant (RUQ) ultra-
sound image is seen below. Which of the following is the most appropriate
next step in management?
Trauma 131a. Emergent abdominal computed tomographic (CT) scan
b. Transfer to the operating room (OR) for laparotomy
c. Perform a diagnostic peritoneal lavage (DPL)
d. Observe until one more liter of crystalloid fluid is administered
e. Serial abdominal examinations
129.Paramedics bring a 17-year-old high school football player to the ED on
a backboard and with a cervical collar. During a football game, the patient
“speared” another player with his helmet and subsequently experienced
severe neck pain. He denies paresthesias and is able to move all of his extrem-
ities. A cervical spine CT scan reveals multiple fractures of the first cervical
vertebra. Which of the following best describes this fracture?
a. Odontoid fracture
b. Hangman’s fracture
c. Jefferson fracture
d. Clay-shoveler’s fracture
e. Teardrop fracture
(Reproduced, with permission, from Ma OJ, Mateer JR, Kirkpatrick AW. Trauma: common and
emergent abnormalities. In:Emergency Ultrasound.2nd ed. New York, NY: McGraw-Hill;
2007: Figure 5-20b.)