144.An 81-year-old woman presents to the ED after tripping over the side-
walk curb and landing on her chin causing a hyperextension of her neck.
She was placed in a cervical collar by paramedics. On examination, she has
no sensorimotor function of her upper extremities. She cannot wiggle her
toes, has 1/5 motor function of her quadriceps, and only patchy lower
extremity sensation. Rectal examination reveals decreased rectal tone. Which
of the following is the most likely diagnosis?
a. Central cord syndrome
b. Anterior cord syndrome
c. Brown-Séquard syndrome
d. Transverse myelitis
e. Exacerbation of Parkinson disease
145.A 22-year-old man presents to the ED after being ejected from his vehi-
cle following a high-speed motor vehicle collision. Upon arrival, his BP is
85/55 mm Hg and HR is 141 beats per minute. Two large-bore IVs are placed
in the antecubital veins and lactated ringers solution is being administered.
After 3 L of crystalloid fluid, the patient’s BP is 83/57 mm Hg. Which of the fol-
lowing statements is most appropriate regarding management of a hypotensive
trauma patient who fails to respond to initial volume resuscitation?
a. It is important to wait for fully cross-matched blood prior to transfusion
b. Whole blood should be used rather than packed red blood cells (RBCs)
c. Blood transfusion should begin after 4 L of crystalloid infusion
d. Type O blood that is Rh-negative should be transfused
e. Type O blood that is Rh-positive should be transfused
146.A 24-year-old man is brought into the ED by paramedics after being
run over by a car. His systolic BP is 90 mm Hg by palpation, HR is 121 beats
per minute, RR is 28 breaths per minute, and oxygen saturation is 100% on
non-rebreather. The airway is patent and breath sounds are equal bilaterally.
You establish large-bore access and fluids are running wide open. Secondary
survey reveals an unstable pelvis upon movement with lateral to medial
force. Bedside focused assessment by sonography for trauma (FAST) is neg-
ative for intraperitoneal fluid. Which of the following is the most appropri-
ate immediate next step in management?
a. Bilateral chest tubes
b. Application of external fixator
c. Application of pelvic binding apparatus
d. Venographic embolization
e. Angiographic embolization
138 Emergency Medicine