Your Patient Is a 21-Year-Old Man with a Single, Small-Caliber

question 9

Multiple Choice

Your patient is a 21-year-old man with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route, the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should:

• A) immediately decompress the left chest and divert to the community hospital for chest tube insertion.
• B) immediately decompress the left chest and continue to the trauma center for chest tube insertion.
• C) continue to the Level I trauma center for pericardiocentesis.
• D) divert to the community hospital for pericardiocentesis.

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Definitions:

Aggressive

Behavior characterized by physical or verbal harm towards others, or by forcefulness to achieve one's goals.

Multitasking

The ability or act of handling more than one task simultaneously or switching between tasks quickly.

Reticular Formation

A network of nerve pathways in the brainstem involved in consciousness, sleep-wake cycles, and filtering out repetitive, non-essential stimuli.

Studying

The act of devoting time and attention to acquiring knowledge on a subject, especially through reading and analyzing material.