Which induction agent for intubation is associated with adrenal insufficiency?

Interosseous access is contraindicated in the following scenario:

85 yo man presents as an alpha trauma evaluation following MVA. He opens his eyes to pain, makes incomprehensible sounds, and withdraws from pain. What is his GCS and next steps?

72 yo man with history of fib on Coumadin, presents after slip and fall. He does not open his eyes, withdraws to pain, and has no verbal response - is intubated on the field. Vitals are 170/60, HR 50, 100% pulse ox. Primary survey reveals bilateral breath sounds, negative eFAST. Both pupils are non responsive and dilated. What is the next step in management?

40 yo woman involved in rollover MVA, prolonged extraction, comatose in field and intubated by EMT. Arrival vitals: BP 80/50, HR 120, 96% pulse ox, pupils initially reactive but now very sluggish to fixed. eFAST positive for fluid in splenorenal fossa. What is the next step in management?

73 yo man with degenerative joint disease sustains whiplash injury in rapid deceleration MVC. Exam demonstrates flaccid upper extremities and preserved motor in lower extremity, variable numbness below the nipple line. What is the diagnosis:

30 yo man sustains crush injury to face from an I-beam at construction site. eFAST negative, GCS 15, and no other injuries or complaints. During secondary survey you find midface instability, and CT max face demonstrates craniofacial dissociation. What additional work up is required?

Patient was struck by a delivery truck, obtunded and was intubated on the field. Initial vital signs are: 80/50 (after 2 u prbcs), HR 125, 98% on ventilator. FAST shown in images. What is the next step in management?

25 yo patient sustains a large SDH with midline shift & grade III splenic laceration (positive FAST but initially HD normal) following an MVC. She is s/p craniotomy with ICP monitoring, and ICPs are 12-15. In the ICU the patient becomes borderline hypotensive and has a drop in Hgb. Regarding this patient's splenic laceration...

3 weeks following successful nonoperative management of grade 4 blunt liver laceration, the patient presents to ED with RUQ pain and nausea. CT demonstrated in image. What is the next step in management?

23 yo man following ATV accident sustains periduodenal hematoma. He returns to the ED 2 days after discharge with nausea, vomiting and inability to tolerate po intake. The next step in management is:

23 yo man sustains periduodenal hematoma from an ATV accident, and is admitted for monitoring. UGI confirms a gastric outlet obstruction, and 5 days later the patient still has nausea and vomiting. What is the treatment?

Patient sustains high speed roll over MVA, HD unstable with positive FAST and taken to OR for ex lap. Injuries identified: splenic hilar avulsion, liver laceration, multiple enterotomies, periduodenal hematoma with associated pancreatic tail disruption. What is the appropriate management?

Which of the following is diagnostic of cariogenic shock?

What is the best incision for suspected LEFT subclavian injury?

Your trauma patient has a Zone 2 hematoma (retroperitoneal) left of midline. What is the most important first step in mobilization?

CT cystography in a trauma patient shows contrast extravasation into the retroperitoneal space. Other injuries include superior pubic ramus and multiple rib fractures. What is correct regarding the management of her injuries:

36 yo female stab victim is hypotensive/tachycardic by responsive to fluids. CT shows retroperitoneal hematoma medial to take off of left gonadal artery without contrast extravasation. What is correct description of this injury and its management?

What is the most appropriate management of a large full thickness extraperitoneal rectal injury 3 cm from the anus, accessible transanally?

What is the best exposure for a distal tracheal injury?

26 yo following an ATV accident presents with chest pain, difficulty breathing and hypoxia. CT chest with reconstruction is shown. What is true regarding the patient's breathing?

24 yo man presenting to trauma bay after motorcycle accident in respiratory distress, is unable to be intubated. During direct laryngoscopy, you are unable to visualize the airway and the patient begins to desaturate. What is the next best step?

During a trauma laparotomy you find non expanding retroperitoneal hematoma and edema in the RUQ, as well as bile staining after medicalizing the right colon. What is the next step?

Swan Ganz catheter is placed and readings are as follows: pulse rate 94, cardiac index 1.5 L/min/m2, pulm capillary wedge pressure 20mmHg, systemic vascular resistance 3000 dynes/sec/cm-5. Which of the following is the best management option for this patient?

24 yo male sustained right 3rd intercostal space pericostal stab wound, initial BP 120/95, HR 110, RR 24. He has a normal CXR and bilateral breath sounds.

Ten min later, BP drops 40/30, HR 140, RR 28. No tracheal deviation and CXR remains normal. What is the most likely diagnosis?

33 yo female presents to ED after MVC with severe abdominal and low back pain, HR 110, BP 145/90. CT negative other than Chance fracture and moderate volume free fluid in abdomen. What is the next best step in management?

45 yo female s/p MVC arrives normotensive but GCS of 8, and is intubated in ED. She is taken for CT which shows several small intraparenchymal contusions and grade IV splenic laceration with blush and moderate hemoperitoneum. Patient becomes hypotensive on return from CT scanner. What is next course of action?

38 yo man brought to ED after being pinned under a car at work, on CXR found to have multiple rib fractures and air-fluid consistent with stomach being above level of diaphragm. Which of the following statements regarding this injury is correct?

6 yo boy brought to trauma bay after being struck by a car with large reported blood loss at the scene. He is tachycardic, hypotensive and not responsive to a crystalloid fluid bolus. Mother reports his weight is 23 kg (50 lbs). What is the next resuscitative strategy?