A 23-Year-Old Man Is Brought to the Emergency Department After

question 28

Multiple Choice

A 23-year-old man is brought to the emergency department after a head-on motor vehicle collision in which both vehicles were traveling at moderate speed.  The patient was a restrained driver in the collision.  He has no significant medical history and takes no medications.  Initially he reports pelvic pain only.  Blood pressure on arrival is 132/65 mm Hg and pulse is 102/min.  He is given bolus intravenous fluids and opioid analgesics for pain.  The patient's cervical spine is clinically cleared for acute fractures, and he is diagnosed by plain film with a pelvic fracture.  A pelvic binder is applied.  One hour after initial presentation, the patient is short of breath and has chest pain.  Blood pressure is 122/70 mm Hg and pulse is 84/min.  Pulse oximetry shows 95% on room air.  Physical examination shows the patient to be in no apparent distress lying supine.  Mucous membranes are moist.  No jugular venous distension or tracheal deviation is present.  The patient is not using accessory respiratory muscles, and no penetrating chest trauma is noted.  Breath sounds are diminished on the right upper lung field with hyperresonance to percussion and absent fremitus.  The abdomen is soft and nontender.  No distension, hepatomegaly, splenomegaly, or free fluid is present.  The remainder of the examination is normal.  Which of the following is the best initial test to assess for the suspected diagnosis of pneumothorax in this patient?

• A)Bedside ultrasonography
• B)CT scan of the chest
• C)Expiratory chest x-ray
• D)Supine chest x-ray, anteroposterior view
• E)Upright chest x-ray, posteroanterior view

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Definitions:

Total Revenues

The total amount of money received by a company from its sales of goods or services before any expenses are subtracted.

Variable Costs

Costs that vary directly with the level of production or sales, like raw materials and labor.

Economic Profit

The financial gain that exceeds both the total opportunity costs of production and the accounting costs, reflecting the additional value created from business activities.

Accounting Profit

The profit a company has after deducting all its expenses from its total revenue.