Trauma 147165.Paramedics bring a 55-year-old woman to the ED after she was struck
by a motor vehicle traveling at 30 mile/h. Her BP is 165/95 mm Hg, HR is
105 beats per minute, and RR is 20 breaths per minute. Upon arrival, she
does not open her eyes, is verbal but not making any sense, and withdraws
to painful stimuli. You assign her a GCS score of 8. As you prepare to intu-
bate the patient, a colleague notices that her left pupil has become dilated
compared to the right. Which of the following has the quickest effect to
reduce ICP?
a. Cranial decompression
b. Dexamethasone
c. Furosemide
d. Hyperventilation
e. Mannitol
166.A car pulls up to your ED and drops off a 19-year-old man who was
shot in the chest. The man tells you his name and complains of right-sided
chest pain and difficulty breathing. On primary survey, his airway is patent
and his oropharynx has no blood or displaced teeth. He is breathing at
32 beats per minute with retractions and an oxygen saturation of 88% on
15 L of oxygen. There is a bullet wound to his right mid-chest with another
wound in his back. His trachea is deviated to the left. On auscultation, he
has diminished breath sounds on the right side. Which of the following is
the most appropriate next step in management?
a. Stat portable chest x-ray
b. Intubation
c. Perform ED thoracotomy
d. Call the surgical service
e. Needle decompression