156.Paramedics bring a 44-year-old man to the ED. He was found in the
middle of the street after being struck by a car. His systolic BP is 70 mm Hg;
a diastolic BP cannot be obtained. The heart rate is 125 beats per minute,
and oxygen saturation is 89% on room air. The patient’s eyes are closed.
You ask the patient his name and he doesn’t respond. There is no response
when you ask him to move his limbs. You notice that his left foot is severely
deformed and there is a large laceration to his right arm. Which of the fol-
lowing is the most appropriate next step in management?
a. Prepare for emergent orotracheal intubation.
b. Begin aggressive fluid resuscitation and administer morphine for pain.
c. Apply a tourniquet just above his left foot and begin fluid resuscitation.
d. Apply pressure to the laceration, splint the left foot, and order a radiograph.
e. Administer packed RBCs and bring him to the CT scanner for a pan-scan.
157.A 17-year-old boy is found unconscious in a swimming pool. He is
brought into the ED by paramedics already intubated. In the ED, the patient
is unresponsive with spontaneous abdominal breathing at a rate of 16 breaths
per minute, BP of 80/50 mm Hg, and HR of 49 beats per minute. In addition
to hypoxemia, what condition must be considered earliest in the management
of this patient?
a. Cervical spine injury
b. Electrolyte imbalance
c. Metabolic acidosis
d. Severe atelectasis
e. Toxic ingestion
Trauma 143