A 24 Y/O M is brought to the ED after a motorcycle accident resulting in a closed fracture of the R tibia. A cast is applied. 4 hours later, the patient c/o escalating leg pain, unrelieved by IV morphine. O/E: BP 130/80, HR 110, RR 18. The R lower leg is visibly tense and swollen within the cast. Capillary refill is <2s and the dorsalis pedis pulse is palpable. He reports extreme pain when his toes are passively extended by the examiner. Which of the following is the earliest and most reliable sign of acute compartment syndrome?

A 24 Y/O M is brought to the ED after a high-speed motor vehicle collision. He was the unrestrained driver. O/E, he is pale, anxious, and diaphoretic. BP is 90/60 mmHg, HR 125 bpm, RR 24/min. Abdomen is tender and guarded, especially in the LUQ. He c/o sharp pain at the tip of his left shoulder. Chest examination reveals equal breath sounds bilaterally with no crepitus. The patient's left shoulder pain is most likely due to irritation of which nerve?

A 35 Y/O M is brought to the ED post-RTA. He is unresponsive. O/E: GCS 8, trachea deviated to the left, absent breath sounds & hyperresonant percussion over the right hemithorax. Vitals: BP 80/50 mmHg, HR 140/min, RR 35/min. What is the most appropriate immediate intervention?

An 80 kg, 34 Y/O M is in the ICU 6 hours post-laparotomy for a perforated appendix. He has received 4L of Ringer's lactate. His current vitals are stable: BP 110/70 mmHg, HR 98/min. O/E, his abdomen is soft and his peripheries are warm. Labs show a serum lactate of 2.1 mmol/L (down from 4.5 mmol/L on admission). You are assessing the patient to ensure resuscitation is sufficient to prevent acute kidney injury (AKI). Which of the following is the most reliable indicator that fluid resuscitation has successfully restored adequate renal perfusion?

A 25 Y/O M is brought to the ED after a motor vehicle accident resulting in a closed fracture of his right tibia. He is given IV morphine, but 4 hours later, his calf pain becomes progressively severe, describing it as a deep, burning pressure. O/E, the R calf is visibly swollen, tense, and firm to palpation. He reports numbness over the dorsum of his foot. Passive stretching of his toes elicits excruciating pain. Distal pulses are palpable. What is the most likely diagnosis?

A 25 Y/O M is brought to the ED following a high-speed motorcycle accident. He is agitated, c/o severe L lower leg pain, which he rates as 10/10. O/E, his L leg is visibly deformed and swollen. He is hemodynamically stable with BP 145/90, HR 115, RR 22, SpO2 98% on RA. He has no other apparent injuries and his GCS is 15. What is the most appropriate initial step in managing this patient's pain?

A 45 Y/O M is brought to the ED after a high-speed MVA. He is unconscious. O/E, he has central cyanosis, paradoxical movement of the right chest wall, and labored breathing. Vitals: BP 100/70 mmHg, HR 125/min, RR 32/min, SpO2 85% on room air. His GCS is 8 (E2, V2, M4). Breath sounds are ↓ on the right side. What is the most appropriate immediate step in management?

A 34 Y/O M is brought to the ED after a high-speed MVA. He was intubated at the scene for a GCS of 7. Primary survey reveals BP 80/40 mmHg, HR 135/min, RR 20/min (ventilated), and SpO2 98%. O/E, his abdomen is rigid and markedly distended. After receiving 2L of crystalloids and 2 units of packed RBCs, his BP is transiently up to 85/50 mmHg but HR remains >130/min. What is the most appropriate next step in the management of this patient?

A 26 Y/O F is brought to the ED by her boyfriend for evaluation of recurrent episodes of lightheadedness & fatigue x1 week. He reports she ‘almost fainted’ today at home while getting up from the couch. This has never happened before. She has no significant past medical Hx & attributes her symptoms to work stress. O/E: Appears tired but is alert and oriented. BP 115/75 mmHg, HR 82/min, RR 16/min, SpO2 99% on RA. Cardiopulmonary and neurological exams are unremarkable. What is the most appropriate next step in management?