147.A 32-year-old man is brought to the ED by paramedics after a diving
accident. The lifeguard on duty accompanies the patient and states that he
dove head first into the shallow end of the pool and did not resurface. On
examination, the patient is speaking but cannot move his arms or legs and
cannot feel pain below his clavicle. He is able to feel light touch and posi-
tion of his four extremities. A cervical spine radiograph does not reveal a
fracture. Which of the following is the most likely diagnosis?
a. Spinal cord injury without radiographic abnormality (SCIWORA)
b. Central cord syndrome
c. Anterior cord syndrome
d. Cauda equina syndrome
e. Brown-Séquard syndrome
148.A 22-year-old man is brought to the ED 20 minutes after a head-on
motor vehicle collision in which he was the unrestrained driver. On arrival,
he is alert and coherent but appears short of breath. His HR is 117 beats per
minute, BP is 80/60 mm Hg, and oxygen saturation is 97% on a non-
rebreather. Examination reveals bruising over the central portion of his chest.
His neck veins are not distended. Breath sounds are present on the left, but
absent on the right. Following administration of 2 L of lactated ringer solu-
tion, his systolic BP remains at 80 mm Hg. Which of the following is the most
appropriate next step in management?
a. Sedate, paralyze, and intubate
b. Perform a needle thoracostomy
c. Perform a DPL
d. Perform a FAST examination
e. Perform a pericardiocentesis
Trauma 139