A 53-Year-Old Man Is Brought to the Emergency Department After

question 109

Multiple Choice

A 53-year-old man is brought to the emergency department after being involved in a motor vehicle collision as an unrestrained driver.  The patient was found unresponsive at the scene and was intubated by the paramedics.  On arrival, blood pressure is 74/50 mm Hg and pulse is 116/min.  The patient is intubated and mechanically ventilated.  The trachea is midline.  There are multiple bruises over the anterior chest.  Breath sounds are present and equal bilaterally, and heart sounds are normal.  A central venous catheter is placed for fluid resuscitation.  Initial central venous pressure (CVP) is 12 mm Hg (normal: 6-8) .  After rapid infusion of 2 L of normal saline, blood pressure is 78/52 mm Hg, pulse is 120/min, and CVP is 18 mm Hg.  Which of the following is the most likely diagnosis?

• A)Anaphylaxis
• B)Blunt cardiac injury
• C)Hypovolemia
• D)Intracranial hemorrhage
• E)Spinal cord injury
• F)Tension pneumothorax

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Definitions:

Cocaine

A powerful and illegal stimulant drug derived from the leaves of the coca plant, known for its euphoric effects and high potential for addiction.

Marijuana

A psychoactive drug from the Cannabis plant, used for medical or recreational purposes.

Inner City

Typically refers to areas near the city center, often characterized by high population density, economic and social challenges, but also vibrant community life.

Poor

A socioeconomic status characterized by a lack of financial resources and access to basic life necessities.