162.A 32-year-old woman is brought to the ED by paramedics after being
involved in a motor vehicle collision. The patient was the front-seat passenger
of the car and was not wearing a seat belt. In the ED, the patient is speaking and
complains of abdominal pain. Her breath sounds are equal bilaterally. You note
a distended abdomen. A FAST examination is positive for fluid in the left upper
quadrant (LUQ). Her BP is 90/70 mm Hg and HR is 120 beats per minute. You
administer 2 L of crystalloid solution. Her repeat BP is 80/60 mm Hg. Which
of the following is the most appropriate next step in management?
a. Administer a vasoconstrictor, such as epinephrine.
b. Administer another 2 L of crystalloid.
c. Administer type O, Rh-negative blood.
d. Bring patient to the CT scanner for an emergent scan.
e. Perform another FAST examination to see if the fluid is increasing.
163.A 27-year-old pregnant woman, in her third trimester, is brought to
the ED after being involved in a low-speed motor vehicle collision. The
patient was wearing a seat belt in the back seat of a car that was struck in
the front by another car. Her BP is 120/70 mm Hg and HR is 107 beats per
minute. Her airway is patent, breath sounds equal bilaterally, and skin is
warm with 2+ pulses. FAST examination is negative for free fluid. Evalua-
tion of the fetus reveals appropriate fetal HR and fetal movement. Repeat
maternal BP is 120/75 mm Hg. Which of the following is the most appro-
priate next step in management?
a. Perform an immediate cesarean section in the OR.
b. Perform an immediate cesarean section in the ED.
c. CT scan of the abdomen and pelvis to rule out occult injury.
d. Discharge the patient if laboratory testing is normal.
e. Monitor the patient and fetus for a minimum of 4 hours.
164.A 61-year-old man presents to the ED with low back pain after slipping
on an icy sidewalk yesterday. He states that the pain started on the left side of
his lower back and now involves the right and radiates down both legs. He also
noticed difficulty urinating since last night. On neurologic examination, he
cannot plantar flex his feet. Rectal examination reveals diminished rectaltone.
He has a medical history of chronic hypertension and underwent a “vessel
surgery” many years earlier. Which of the following is the best diagnosis?
a. Abdominal aortic aneurysm
b. Disk herniation
c. Spinal stenosis
d. Cauda equina syndrome
e. Osteomyelitis
146 Emergency Medicine