149.An 87-year-old man is brought to the ED on a long board and in a
cervical collar after falling down a flight of steps. He denies losing con-
sciousness. On arrival, his vital signs include a HR of 99 beats per minute,
BP of 160/90 mm Hg, and RR of 16 breaths per minute. He is alert and
speaking in full sentences. Breath sounds are equal bilaterally. Despite an
obvious right arm fracture, his radial pulses are 2+ and symmetric. When
examining his cervical spine, he denies tenderness to palpation and you do
not feel any bony deformities. Which of the following is a true statement?
a. Epidural hematomas are very common in the elderly age population.
b. Cerebral atrophy in the elderly population provides protection against subdural
hematomas.
c. Increased elasticity of their lungs, allows elderly patients to recover from tho-
racic trauma more quickly than younger patients.
d. The most common cervical spine fracture in this age group is a wedge fracture
of the sixth cervical vertebra.
e. Despite lack of cervical spine tenderness, imaging of his cervical spine is
warranted.
150.A 41-year-old man who was a restrained front seat passenger in a high-
speed motor vehicle collision is brought to the ED by the paramedics. His vital
signs are BP 90/50 mm Hg, HR 125 beats per minute, and RR 20 breaths per
minute. On examination, he is alert and answers your questions. His breath
sounds are equal bilaterally and chest wall is without contusion or bony
crepitus. The abdomen is soft and nondistended. His pelvis is unstable. A FAST
examination and DPL are negative for intraperitoneal fluid. Initial radiographs
reveal a normal chest film and an open book pelvic fracture. Despite infusion
of 2 L of lactated ringer solution, his BP is now 80/40 mm Hg. Which of the
following is the most appropriate next step in management?
a. Immediate exploratory laparotomy
b. Pelvic angiography with embolization of the pelvic vessels
c. CT scan
d. Pericardiocentesis
e. Retrograde urethrogram
140 Emergency Medicine