A 19-Year-Old Man Is Brought to the Emergency Department Due

question 1

Multiple Choice

A 19-year-old man is brought to the emergency department due to suspected hypothermia.  He was found by police after his family reported him missing 8 hours ago.  He appeared to be intoxicated and was sleeping in the snow without gloves.  On arrival, temperature is 35 C (95 F) , blood pressure is 140/86 mm Hg, and pulse is 112/min.  The patient is sleepy but arousable to verbal stimuli.  Examination shows no signs of trauma to the head or neck.  Pupils are equal and reactive to light.  Heart and lung sounds are normal.  The left hand is pale and cold; the fingers appear grayish, with sensory loss to the level of the metacarpophalangeal joints.  Plain radiographs of the hand reveal no fractures.  Rewarming with heated blankets and warm intravenous fluids is started immediately; the left hand is submerged in a 38 C (100.4 F) water bath.  Thirty minutes later, body temperature is 36.5 C (97.7 F) , but there is persistent sensory loss, and the left hand is still grayish.  Which of the following is the best next step in management of this patient's condition?

• A)Amputation of the fingers
• B)Angiography of the left arm
• C)Increased water temperature to 50 C (122 F)
• D)Nerve conduction study
• E)Warmed peritoneal irrigation

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Definitions:

Marginal Disutility

The additional dissatisfaction or negative utility a person receives from consuming one more unit of a good or service.

Successive Unit

The next unit or piece in a series or sequence, often used in the context of production or consumption.

Framing Effect

The cognitive bias where people's decisions are influenced by the way information is presented rather than the information itself.

Relatively Cheap

A term used to describe goods or services that are considered to be priced lower than their perceived value or compared to alternative options.