159.A 22-year-old man is brought to the ED after sustaining a single gun-
shot wound (GSW) to his right thigh. On arrival, his HR is 105 beats per
minute and BP is 115/75 mm Hg. You note a large hematoma of his medial
thigh. The patient complains of numbness in his right foot. On extremity
examination, the right foot is pale and you cannot palpate a distal pulse but
can locate the dorsalis pedis by Doppler. In addition, the patient cannot
move the foot. Which of the following is the most appropriate next step in
management?
a. Angiography
b. Exploration and repair in the OR
c. Fasciotomy to treat compartment syndrome
d. Wound exploration
e. CT scan of the right extremity
160.A 67-year-old woman is brought to the ED after being struck by a
cyclist while crossing the street. On arrival to the ED, her eyes remain closed
to stimuli, she makes no verbal sounds, and withdraws only to painful stim-
uli. You assign her a GCS of 6. Her BP is 175/90 mm Hg and HR is 75 beats
per minute. As you open her eye lids, you notice that her right pupil is 8 mm
and nonreactive and her left is 4 mm and minimally reactive. Which of the
following is the most common manifestation of increasing intracranial pres-
sure (ICP) causing brain herniation?
a. Change in level of consciousness
b. Ipsilateral pupillary dilation
c. Contralateral pupillary dilation
d. Significantly elevated BP
e. Hemiparesis
161.A 34-year-old man is brought to the ED after being shot in the right
side of his chest. The patient is awake and speaking. Breath sounds are
diminished on the right. There is no bony crepitus or tracheal deviation.
His BP is 95/65 mm Hg, HR is 121 beats per minute, and RR is 23 breaths
per minute. Supine chest radiograph reveals a hazy appearance over the
entire right lung field. You place a 36F chest tube into the right thoracic
cavity and note 1200 cc of blood in the chest tube drainage system. Which
of the following is an indication for thoracotomy?
a. 500 cc of initial chest tube drainage of blood
b. 1200 cc of initial chest tube drainage of blood
c. Persistent bleeding from the chest tube at a rate of 50 cc/h
d. Chest radiograph with greater than 50% lung field white out
e. Evidence of a PTX
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