06-22-2014, 06:41 PM
27.
A 27-year-old man is brought to the emergency department by paramedics 30 minutes after being involved in a high-speed motor vehicle collision in which he was the unrestrained driver. He was unconscious at the scene, and he was extricated from his vehicle. On arrival, his Glasgow Coma Scale score is 10. His temperature is 37°C (98.6°F), pulse is 130/min, respirations are 36/min, and blood pressure is 90/60 mm Hg. Breath sounds are decreased on the right; there is crepitus to palpation over the right hemithorax. An x-ray of the chest shows a right hemopneumothorax. Abdominal ultrasonography for trauma (FAST) shows no abnormalities. An x-ray shows an unstable pelvic fracture. Placement of a right thoracostomy tube yields 300 mL of blood. After rapid infusion of 3 L of crystalloid, the patient remains tachycardic and hypotensive. Which of the following is the most appropriate next step in management?
A
)
Administration of epinephrine
B
)
Administration of hetastarch
C
)
Administration of recombinant factor VII
D
)
Transfusion of fresh frozen plasma
E
)
Transfusion of group O, Rh-negative packed red blood cells
A 27-year-old man is brought to the emergency department by paramedics 30 minutes after being involved in a high-speed motor vehicle collision in which he was the unrestrained driver. He was unconscious at the scene, and he was extricated from his vehicle. On arrival, his Glasgow Coma Scale score is 10. His temperature is 37°C (98.6°F), pulse is 130/min, respirations are 36/min, and blood pressure is 90/60 mm Hg. Breath sounds are decreased on the right; there is crepitus to palpation over the right hemithorax. An x-ray of the chest shows a right hemopneumothorax. Abdominal ultrasonography for trauma (FAST) shows no abnormalities. An x-ray shows an unstable pelvic fracture. Placement of a right thoracostomy tube yields 300 mL of blood. After rapid infusion of 3 L of crystalloid, the patient remains tachycardic and hypotensive. Which of the following is the most appropriate next step in management?
A
)
Administration of epinephrine
B
)
Administration of hetastarch
C
)
Administration of recombinant factor VII
D
)
Transfusion of fresh frozen plasma
E
)
Transfusion of group O, Rh-negative packed red blood cells