vital signs. Otherwise, patients should go directly to the OR to undergo
exploratory laparotomy.
155.The answer is a.(Rosen, pp 933-935.)Posterior epistaxisis identi-
fied when posterior bleeding occurs with a properly placed anterior nasal
packing. Posterior packing is mandated using either a commercially available
balloon or a standard Foley catheter inserted into the posterior nares and
inflated with water. Patients with posterior nasal packs should be admitted
to a monitored bed. In addition to cardiac dysrhythmias, myocardial infarc-
tions, cerebrovascular accidents, and aspiration have been reported in these
patients.Antibioticsare often started to prevent sinusitis and toxic shock
syndrome from obstruction of the nasal packing.
(b)Placing the patient supine increases risk of aspiration and has no
benefit to stopping epistaxis. (c)If the patient had an elevated INR or was
thrombocytopenic, then fresh frozen plasma (FFP) and platelets should be
administered. (d)Patients with posterior nasal packing require admission.
(e)Silver nitrate is a therapy for anterior epistaxis. It has no role in poste-
rior epistaxis.
156.The answer is a.(Hamilton et al, pp 17-18.)Patients often present to
the ED with life-threatening conditions that require rapid and simultane-
ous evaluation and treatment. The fundamentals of emergency medicine
begin with the ABCs. Airway assessment and management have prior-
ity over all other aspects of resuscitation in the critically ill or injured
patient. Moreover, airway management is not simply the passage of a tube
through the trachea. It involves a series of actions ranging from reposition-
ing a patient’s head and neck, suctioning secretions in the posterior pharynx
to supplying supplemental oxygen or performing an emergent cricothyro-
tomy. Whatever the intervention, it is important to know when and how to
manage an airway. There are many reasons for definitive airway management
with an orotracheal tube, the obvious being in patients who are not breath-
ing. However, there are instances that require definitive management even
when a patient is spontaneously breathing. Any patient who is at risk of los-
ing the ability to protect their airway should be considered for intubation.
This includes intoxicated patients, the poisoned patient, worsening hypoxia,
those with evolving laryngeal edema or hematoma near the trachea, and
patients with significant head injuries. Once the airway is addressed, it is
appropriate to move onto the next critical component of the ABCs.
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