MCQ ATLS 9TH ED 1

(1)

ATLS 9

£d1tlon

I •

2.

~.

.

·sophageal

' ·

.

_1·

bl for

diagnosing

c

'!'

h11:h

ol

the

roJioy,mg

s1gns

1S LEAST

re

13 e

Intubation?

n.

S)mmclrical chest \\all mo,ement

h.

end-tidal

C02

presence b' colorimetl')

c

.

bilateral breath sounds '

d.

oxygen -.aturation

>92°/o

c. L I I abo'

e carina on chest

x

-ra\

_•

WI

· h

·

· · in

sc'-erc

trauma

1

!c one of the folio'' ing signs necessitates

a ddimU'-e mrwa)

pat•cnts'!

a

· facial lacerations

h.

repeated vomiting

c.

sc\crc maxillofacial fractures

u

.

~tcrnal

fracture

c

.

<ilm.gow Coma Scale score of

12

'I

~cnty

· ~even

patients are seriously

injured in an aircraft cras

h

at a loca

l

a

ir

po

rt

.

Th

e

pnnc1plc\

nf

triage

include:

<1.

e-.tablish a triage site

within the interna

l

perimeter of t

h

e c

r

as

h

s

ite

b

.

~rcat o~ly

the

most

severely

injured patients first

c

.

•mmcdmtcly transport

all patients to the nearest hospita

l

u

.

treat the greatest

number

of

patients in the shortest pe

r

iod of

time

c.

produce

the

greatest

number

of suniYors

based on available

r

eso

urce

s

L

Which one of

the

follo

.... ing

statements is

correct?

s.

a

.

Cerebral contusions

rna)

coalesce

to form an intracerebral he

m

a

t

o

ma.

h

.

Epidural hematomas are

usuall}

seen

in the frontal region.

c

.

Subdural hematomas are caused

b}

injul) to the middle me

nin

g

e

a

l a

rt

ery.

d.

Suh<.lural hematomas

t)picall)

ha"e

a lenticular shape on

CT

sc

an.

c.

I

he

a:.~ociated

brain damage is

more

se,ere

in epidural hema

t

o

mas.

An

18-ycar-old male is brought

to

the emergenc} departmen

t

a

fte

r

hav

i

ng

been

s

h

o

t

.

J

tc

has

one

bullet wound just belo'' the right cia" icle and anoth

er

jus

t be

l

o

w the

costal margin in the right posterior

axilla~

line.

IIi~ ~lood

press

ure i

s

II ?

'

60 mm

Hg.

hcurt

rate is

90 beats per minute, and resptratory

~te

1s 34.breaths

per

mm

ute

.

After

· at•nt airway and inserting

2\arge-cahber

IV

hnel., the

appropriate

cnsunng

a

P•

c

s

t

ep is to:

11

obtain a portab

l

e chest x-ray

.

h·.

adm

i

n

i

s

t

er n

b

o

l

us of additional IV flUid

c. perfo

r

m a

l

aparotomYCT

d

. o

bt

ain a

n

ab

d

ominal . sceanllavaoc

c.

perf

o

r

m diagnos

t

ic penton a

o

e

c

e

a

contusions may coalesce to form an intracerebral

hematoma.

www.neuroanimations.com/ TBI/ICH.html

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thi'

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b

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A narrowed pulse pressure is not seen in

neurogenic shock.

http://www.surgeons.org.uk/advanced-trauma-life-support/shock.html

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ss

during

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i

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s

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SC\li'C

of

I

5. Her

only

complaint

is

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slight

~tit.

1'ttil't\

fh~

t'ICC~'mcs

unresponsive

with a

Glasgo"

Coma

Scale

~'ft! ,,, ~- )fl

pupil

is

large

and

n

o

nreactive

.

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right pupil

i

~1.

Tht

,"'nt NN

in

.

iul)

m

os

t

cons

i

s

tent with thi

s

patient'

entire

clink•

I

rou

a

.

a

s

ubdural hematoma

b

.

an epidural hematoma

~.

an occipital

lobe hemorrhage

d

.

t

bca

l

subarachnoid

hemorrhage

c

.

a cerebellar

hemorrhage

c

Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliantFull-thickness circumferential and

near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue deat .

http://emedicine.medscape.com/article/80583-overview

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b d d https://www.scribd.com/mobile/document/318759080 /ATLS-MCQs

a patient with gunshot , BP 70/0 , Chest tube drained 120 ml , chest sounds normal. next step?

(5)

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18.

A

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i

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Aft

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ophageal

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c

heobronchial

injur

A

22-y

ear-old female

wh

o

is

6

m~mths prc~nant

pre

sen

ts

f

o

ll

o

w

i

n

g

a

m

o

t

o

r

v

ehicl

e

crash.

P

aramedics reJX

• rt

vaginal

hl

ccdlng

.

What

i

s

th

e

initial

s

tep

in

h

e

r

treatm

e

nt

?

assess

fetal h

eart

so

und

s

a

.

b

.

check for fetal

movement

c.

pcrfonn inspection

of

the

cerv~x

d. ask

the

patient what her name

1 s

.

insert

a wedge

under

the patient'

s

r1

g

ht

h1p

e.

a

d

e

(6)

ATt.s 9"' ldltlon

20.

21.

22.

A constru ·

dcparune~uon_ worker falls from a .

of lo\.\er

a

~

~~s.hean

rate is ₁₂₄

an~~~ and~ ~sfe:1ed

to the coeT:>tXXY

spine and . .

~ma

l

pain. After a . pressure b g, 60 mm H:. He ax:-;..azc.

· Initiating nu·d .

.s~smg

the air\.\ a) and chest.

~r

· _.,.

_

I

re

susc

Jtauon the . IZm:c '"""" c

-n.

F AS-...

·

next step tS to perform:

' I e)(am

b. dctai led n .

c. rectal eurologlcal exam

exam

d. cervical spine x-ray e. urethral catheterization

A 22-year-old male susta'

range. His blood press 1

~

5

;

:.

~

o

t

gun

" ound to the left shoulder and cr:.es:. ;nc\cse

After 2 liters

ofcry

s

ta~:~

s

~ ~

0

mm Hg. and his heart rate is 130

beazs

~c~'2

to 122/84 mm Hg and h I so uudon are rapidly infused. his blood pres-w;e

U::..eases

.

· h . • eartrate ec 100 .

\.\It a respLratory rate of 28 b reases.to beats per mm\Jl.C. He i5

uC::.:

,x-e,c

sounds are decreas d h reaths per mmute. On pb)sical exam.in3tic"L .:S bee!::'

caliber

(36 F

h}e at l e left upper chest ,,jth dullness on percussion. ,\

1.:!---- rene tube thoracosto · · lttd · •

:-the return of200 mL f bl d my

~

s

mse m the fifth intercosul sp:ore

-c

o oo and no a1r leak. The most appropriate oe:n

step~

w:

•

a. msert a Foley catheter

b. begin to transfuse 0-negative blood

c. perform thoracotomy

d.

obtain aCT scan of the chest and abdomen e.

repeat

the physical examination of the chest

Which one of the following statements concerning spine and spina'.

cord

{I'a'Ol'tl3 \5

true

?

a. A normal lateral

c-spine

film

excludes

in jut')

.

b.

A

vertebral injury is

unlikely

in

the

absence ofph)

si

ca\ fmd

ingsofarord

\nj~

-c.

A

patien

t

with a

s

us

pected

spine injW') requires imm

o

b

\\iz.:

n

ion on

a -

hort

sp\ne

board.

d.

Diaphragmatic breathing in an

unconscious

patient"

ho

h

as

fulkn

is

a

sign

ot .:

-spine

injury

.

e

.

Detennination

of

whether

a

spinal

cord

lesi

o

n

is

co

mp

l

ete

or

incomplet

e

mus

t

be

made in

the

primar)

sur.

e}.

a

e

(7)

I

IIIII!

t

l

I

I Ill Loll Phl111<ll'" Ill Oilllll!hl ICI\h '

I

• : I" '

''"'

I

"'"'q

• II

n ""

1 llo

"'"''''"'Y

d• P'"'"'.""l"''

flolllr•o••

,.,.

'lhnl

pt

... '""'"

ito \HI

mm

II I

h

'"·~

~~rw~

y

h,

c;.lt!Br r•

.pt

Mury

rate''

21S

orld

yi>\.QJIC

' ""

'I "'"

hi•

1

~

o • " , 1 ""

~

""

,~

I

~

'

"I'

quo

I

""""' '"'

1.-looidc> uttl c ""

• h~

>~•

l

\II

hidl tnt.:rl/1.!111 iun

Is

n~u~t ~

~

~~~;~yn:~~e~!lmplains

Il

l

pain

''"

pelp;t.lllln

of

!1

~~~··

~

l

i!J

ch.1tllll1('1rl!ti~ion

oftlw

c

hc

..

l

h 1

1' 1 '~ ur~ltrw~

nlc

..

i

s

I jM HI llllllllll:!l'lll< fll d 1\lllllll'l\liiOI~

~

lltl" tlutru•

·n,

tomy

I

h

·

Ullllol l'UIIIIllilH

ud~

bu .. .:

db

t

urhancc

encoun

t

ered in injured

nrdt lrk n

\

~~

""'" J

h>

~

,. - · '

,, ''' 1, I Uti hup~

h

l hclll~l·~

Il

l

11\'llllhltlllfl

• ''"

"'"

'' hllllll

l'

.I

11\IIHhl hlll.,

ht.:nrbona

t

l.!

uJm

• OI'•\nUion

'

lu

..

ull

l'"'

"'

..

u

.J

u

n

h

l\lridc:

sJministl't\tion

• o

I

!

• I

,

.,.

,

"

'" ""

'"" "

bro

u

~

h

t

o

the emcraeney depanm

cnt

l<oll•>wi"'l

?...m<:ter

h»

• ll

I• II

"

"'

" ""

'"

\

he ;, u

n

re,pan

i.e

•nd found t

o

h.-e •

·~'"""

• hlo"

o

J ""'

"

,,

r

>)()

1 60 mm

It

g. and h .. n r•"

of

M

.

I

h<:

ftr>t

p

o ..

j" . .

i

It

h

,

,dmtnl

~

h

:

r

ing v

n

.,o

p

r

c

.. sors

"

'

"tuhll.,hin

~

IV

u~

c

's

f

or

d

ru

g·a~.,i~tcd

intuh:ttiOO

'll

'"'~ In~

th~

~a

use

of

her

d

cc

r

ea'\C

d \

eve\

of

con~iou~nes~

uppl

}

i

n

~

U\)

~

en

and

mainta

i

n

i

n

g

uirway

'-

'

'~

· hading

hcn1nrrhu

g

c n

s

u

ca

u

'\C

of <;hock

The laryngeal mask airway (LMA) is a supraglottic airway device

d

c

b

(8)

\\ hkh 11"C l1fthc ll•lhm intt

~lutctncttl'~-

j, true rcgntd'"l! tlittlln•• Itt ptrtt'" I llf'llll

0

• lWt ho' nv utilit in the

diu

!lno~i~

l'fdinphta!!rnati< rupture

h. I>PI

~honld

he p;lrlimm:d whcnuvcr 1111 httltcolit•n h•r hp trot •mV

fot

PI'

fit

c IWI ha!. u hii!h 'JlCcilicit\.

~

:

I )I' I ctm he U\ed 1\tr

dln~lll~ing

rc!rttt>eriltlflcnl

iniuru:~

I>

PI ha:. n hi~o~h M.:n,ith ih. ·

•

~ htch on~: 11f

the

f

11

1

·

· .

(. • • o 11w 11!! stgtt~ ts n~soctntcd with dos~ II hc:mhrrh 1 •6 M It

c:-tunatcd

bluod

lo~s \lf7S0-1500

ml

)'!

u.

hc.an

role

nbovc 140 beats

per

minute b.

urtn~

output

lc

~~

thnn 15 tnl per hout

~:. rc~pii'I.HOI) rotc shove 35 hrcuth, rer tttlmttc

d

.

dccrcu~d diu,tolic

bl

ood

pre~surc

c.

normul~o)stollc

blood

prc

ss

ur

t.:

:!9. Ncul'\)gcnic :.hod. k

n

.

diagno

s

ed

by

the pre

cnce o

l

nat:cid paroly~i~

h. cuuscd b) bruin injul) C. due lO llCUlC hC111llrrhagc

d

.

d

u

e

to dccrcru.cd

'

nsc

u

lur resi

s

tance

c. initially munugcd with VUS\1prcssor the111py

JO

.

A

23 ·)Car

-o

ld

male

i

s

admitted t

o t

h

e emergen

cy

dt(lillhttl'nt

t.lt

r

t

tlv »fler

t•~t,unm

full-thickn

ess

bum

s

10

hi

s

head

,

11rms.

and

up~r tnt"o. totnhn~ot ~(~

.. f>f

ht!l h•\ •I

bOO)'

s

urfa

ce n

n:a.lle weigh

s

80 kg

(

18

5

poumh) Jlj<; hh'tld rn:~~ureo

''

lh~fl~ mrn Jl

and hean rate

is

13

5 beats per minute

.

A

u

ri

n

ury

cnt

h

ctcr

I~ ut~c:rtc:d Wtth

th

r~htfl\ (>(

20 rnl

o

f

dark

amber

urine

.

H

e

ha

s

rec

eive

d

I 000 m

l

,,r

Rtngd~

In

1

tc

,fu tt•tt

s

ince

the

time

of

his

injury

.

U

s

in

g

the Parkl

a

n

d

l

brmulaoc;

lll!lllll(, ht

e

um ue<:l

cry

s

talloid fluid resuscitation

v

o

lum

e

per

hour tbr the nc't

It

h(lnf'

hhuh1

a

.

667mL

b

.

87Sml

c

.

I

OOO

m

L

d

.

1 800mL

c

.

2000mL

e e e b

(9)

32.

33.

.... 110n

A 34-,car I

dcP3rim -o d female in'IOolvea •

bnlising

e::!~~llcang.

Cu1 :ra

~=IS=~

and antericr r.eclc ar>d

a d' oatJS .ene

· •rect J.an.ng

b. OX\ " OSCopy to CXelude h~,

.• gen b) non-rebreath· ....

,T,;;-...a:.

trlmr.a

c. protect the spine b mg mask

d. palpation of the

•=ll'!a

her fie down

e. attach a pulse o . neclc

Xtmeter to her i

~

Compa~·d _{•... "'It}· h _adults _ch"ldr

• • en !-.ave: a. a longer. wider. funnei-'Shapel .

h. a less pliable:. calcified

sketC:U:..r

i3Y c. lo"'er incidence of borl - • •

d.

a

relath el) smaller

h~

~rr.._

;itt:

_neur...gen~e

sflcck

e. ante · d' ... '!tt Ja';\i

rtor rsplacemcnt of C5 on

C6

A 30-)car-old m 1 fi

re . . a c present'> ollowing a motor ~lucie cosh •

sprratol) rate 18. hcan r.rte 88 blood

~

-

.:a

S ·ale 13 • pressur-BOJ - mm g; :rnd. ...

\; !>Core · Laparotom!' is indicated

r.en~

. ....,,..,.

a. there

is

a

distinct

seat

belt si~

over

tne

acdomer.

b. the

C:

sc~n demonst.-ates a ~race A L-.~ic n1ucy c. there rs e\rdence of an extraperitoneal.;.;;dder ir.'ur

d. CT demonstrates retroperitoneal air •

e. the abdomen is distended v.ith locali:wf r:ght uppc:' cwa&--...nt•l=:11.dt;ne<~

34. A 20-)ear-old male is brought to the hospltai

app~

mluruti::>

:il~·~~~

stabbed in the chest. There

is

a

3-<entlmeter

;c.w".d JUSl medial :tritu.sk· ' , .,.

blood pressure

is

70

33 mm Hg.

and

heart l.'3te tS .!0 e:k and .ann .:;re.

distended

.

Brea

th sounds are normaL Hear:

SCWids

are Juninishcd.

:K---

~

been

establ

is

hed

and warm crystalloid

is

in:fus,rr.g.

1.-.e

Qe:X1.tnost

unpi"~

immed

i

ate mana

gement

is:

a

.

CT

scan

o

f

the

c

hest

b. 12-Jead ECG

c

.

left tube

thoracostom~

d.

begin infusi

o

n

o

f pac

k

ed

RBCs

e.

FASTexam

b

pseudosubluxation" at C2/C3 - a posterior step may be seen,

Neurogenic shock can result from severe central nervous system damage

Children have a higher incidence of complete spinal cord injury without radiographic abnormalit c

d

(10)

'

,,,

flll•fl

H • ill 11ltl

''"'"11\)~11

II• bwuglttln urtcr u frorrta1 1mpact

colh~•on

tits \Ita\

1 ' " '" h,i!ll r '' I Ill hlutid '" urc 8'• (,(1 rnrn Jig. and

r~pnaiDf)'

rate 36 nrcalh

' 111"'1 llu O•lfinnl II "WlllrlulnntgiJIUcrl) of lov.cr

ahdomirt:~l

p:un lllcrt:

seems

"' 1" 11 1, ll 1 111!•h

dt~~·

tlllll~)'

und tXtcrnol rvtauon of the

ten

leg. \\'hJCh one of the hllht\\ •IU I •• 111 Itt t:tlt~Cfiiiii!J tlu Jlltllcnt I\ I rut?

'

I'• I\ •• 1111"' (IIIII>~: rut d nut lta'ICd on the rncch:uusm of injury. ''" llhth '" lllll\lltl; I) ha~ II dl Uti rcmur frKlUrC

~ tll ft t•l tit• ~ h "' ""'' JlclVtlltrc nntKJrtant•n the initial evaluauon lntlllltll .lnlllll•l"ll'\ '"'"' nlthc lett lvwcr ltmb i~ expected.

""'"'I''

•Ill I tlll>C 111 \Itt"" huulll he \On idtrcd

\

'~

I""'

11lol h IIIIth:'

lull~ llt~\\n

n lltuht ul tnirJI. She has extensive bruisinS of her

11 " d 'to~

"' tuhllh 11.1 I II 1

lt~:tul

till

~

" 1211, hluud

prcs~urr:

is 'J()/70 mm II g. an rcspll'll •

tnh' •~ 'II Ill("'''"'"''" '"lllllllltttl~ llllt\lu:.uhly explained by:

II "" .,,l,ttnllh'•td til jill y

h '""'''''''"''" lt.un ,,J,.Jonllnnlw pelvic injury

' llll 1111111 lllhl\ h 11111111

d pi11.11 5hlll J.; ltullllCIVIl•IJ •J'IIIC: injury

•' ll~'"'"l!~llh lui\:

I\"'''"

~c:rviutl •JIIIIC injury

17. \\hi, h ""' .. 1 the lolhJ\\

'"I>

t.1to:m~nt~

"true c(lnccming cranial anatomy?

1S.

II lllC '',tip is lllllljK.JSCd ol

~kill,

uhC:UtilllCOUS tissue, galea aponeurotica,JOOSC

Ill l'< •lt~r IISMIC, 111.! dur11

I> I h.·

llll'""'S~'·

IIIC

~ompn.;cd

ul the

uuro~,

pia, arachnoid. and cystema.

t . I ft,• nu.l.llc uumtngc.tl arh:ry ltes bct\\ccn the: dura and pia mater.

d I he l'lhlltti.lr>leAII5, \\llldt produces

ccrebro~pinal

fluid, lies in the lateral and

thud \ ClllrtliCS

~·

lin• h:na.uilltlllerchcllt!ICJ>arntes the cerebral

bcmisphcres

from

the temporal

lotiii.'S,

\ .!.!•\l'·"

,,1,1 ''''""

'

"

fall~

1\hilc skiing.

She

prcsenb on a spine board "" : ·

c~n

ica\

~

oll.u:

,,,~

c''"

m.1~k ,tt

S

I •

und

t\\o antecubital

IVs. I

ler Glasgo\\

Coma

"~a.c

,core

is

12.

pupils ,trl' t'qtrnl, hlnod pres\ltre is

135176 mm

Hg.

hcan

rate

b

1

O'> ,md

rl'spi

1,11111

>

Ill It' is I 1), < hcst \•r!IY is normal. 1 his patient's

management

priorilic~ are: ll ( ·

1

ul

ll

w

h

e

ad

und

rcpctll C

ila

sgow

Coma

Scale

I

), tkliniliH' aimuy.

c

· t

n

f

rh

c

head

. a

n

d in

t

racranial pressure monitor

l'

1 y

ru

n

nn

it

n

l

.

dclin~ri.vc

airwa

y

.(' I

,,~ the h~:ad.

and ncurosurgcl')

COthuh

If

(

·

1 u

f rhc

ltcud.

U

<•

.

c

e

rebr

a

l

perfu

siOn pressure monitorinu and h\ ,

~·

• pc

n

ontc

· s

a

I

in~·

c

.

I

V

_{1 >i}

lt

tntin

.

IV manni

t

ol, m

i

l

d

h

y

perv

entila

t

ion. and serial ane

r

ial

bl

ood g

a

se

-c

b

d

(11)

39. A

~

oung

male

patient

is

brought t

o

the

emergency

dcp

3nmen

t

foll

ow

in~&

5-met.:r

(1

6-foot) fall from a

roof.

He

respond

s

to pain

b)

pu

s

hing

nwoy

your

hand

,

op;;nlll~

his

eyes,

and

verbalizing

i

nappropr

ia

te

words.

Pupil

s

ore equal

.

Th

e

m~l

hnporhtnl

s

tep

in

mana

g

ement

of

thi

s

patient

would

be

:

a.

immediate

i

ntubatio

n

to protect

hi

s

airway

b.

admini

s

ter

25 mglk

g

IV

bolus mannitol

c. insert nvo large

-

bore

IVs

d

.

alcoh

ol

and

drug

scre

enin

g

.

e. detennine

w

heth

e

r

amnesia i

s

pre

se

nt

and.

if

so,

for what peri

o

d

o

fum

e

40. ln

a patient

with

a

s

pinal

cord

injury

,

sacral sparing

:

a. refers

to

a fracture

of

the sac

rum

b

.

is

part

of

the

s

pinal

s

hock

syndrome

c. is

a

good

progn

os

tic

sign

d.

is

diagn

os

tic

of

a Power's ratio

<

I

.

d

e

. occurs only

with

co

mplete transection

of the

lumbo

saccal

s

p•nal

co

r

a

(12)

Mlllt;l lliUI 111.-Uill'lff Ul ~llflJl'OltD

MuiHpl

c-r

hoit

· \·

Rt'!'IIHin 'it'

Sheet

ATLS

®

Writh'n

P

os

t

-

h

.

• s

t 113

(l~r' iwd 201.')

N;mlc

Ah~M.l=<o...

'rv.eM. ...

osrv,blu~.P ~

).u~

, _ .

1

Course Site

_{- - -}

_{- -}

-l,n•portnnt instructions: Use a pencil only. If y~1u l'l•nngt• u rt·~J'Km~·. pknsc crtt~c your fitst mark completely.

Select the one best answer according to the AILS' Cou!'Sl' content

3-1.

(a)

_(b)

_(c)

_(d)

_3-21.

_(n)

_(b)

_(c)

_(d)

3-2.

_(a)

_(b)

_(d)

_(c)

_3-22.

_(a)

_(b)

_(c)

_(e)

1-3.

_(a)

_(b)

_(c)

_(d)

_3-23.

_(b)

_(c)

_(d)

_(e)

3-4.

_(a)

_(b)

_(c)

_(d)

_3-24.

_(a)

_(b)

_c

_(d)

_(e)

3-5.

_(a)

_(b)

_(c)

_(d)

_3-25.

_(b)

_(c)

_(d)

_(e)

3-6.

(a)

_(b)

_(c)

_(d)

•

_3-26.

(a)

(b)

(c)

(e)

3-7.

_(a)

_(b)

_(c)

_(d)

_3-27.

(a)

(b)

(c)

(d)

3-8.

(a)

(b)

(c)

(e)

3-28.

_(a)

_(b)

(c)

(d)

3-9.

_(a)

_(b)

(d)

(e)

3-29.

_(a)

_(b)

_(c)

_(d)

3-10.

(a)

(b)

(d)

(e)

3-30.

(a)

(b)

(d)

(e)

3-11.

.I)

(b)

(c)

(d)

(e)

3-31.

(a)

(

(c)

(d)

(e)

3-J 2.

(a)

IJ)

(c)

(d)

(c)

3-32.

(a)

(l'i)

(c)

(d)

(e)

3-13.

(a)

(c)

(d)

(e)

3-

33 .

(a)

(b)

(c)

(e)

3-14.

(a)

(b)

(c)

(

(e)

3-

34. (a)

(b)

(c)

(d)

3-15.

(a)

(b)

(c)

(e)

3-35.

(a)

(b)

•

(d)

(e)

3-16.

(b)

(c)

(d)

(e)

3-36.

(a)

(b)

(c)

(

d

)

>

3-17.

(a)

(b)

(c)

(e)

3-37.

(a)

(b)

(c)

(e)

3-18.

(a)

(b)

(c)

(d)

•

3-38 .

•

(b)

(c)

(d)

(e)

3-19.

(a)

(b)

(c)

•

(e)

3-39.

•

(b)

(c)

(d)

(e)

(13)

(14)

(15)

Multilumen Esophageal Airway Multilumen esophageal airway devices are used by some prehospital personnel to achieve an airway when a definitive airway is not feasible (n FIGURE 2-9). One of the ports communicates with the esophagus and the other with the airway. The personnel who use this device are trained to observe which port occludes the esophagus and which provides air to the trachea. The esophageal port is then occluded with a balloon, and the other port is ventilated. A CO2 detector improves the accuracy of this apparatus. The multilumen esophageal airway device must be removed and/or a definitive airway provided after appropriate assessment.

(16)

When diagnostic peritoneal lavage (DPL) is used to detect diaphragmatic injury, a false-negative result may occur

An isolated penetrating injury from the chest can cause bleeding into the lesser sac, which may not communicate with the rest of the peritoneal cavity. A DPL in this situation would show no evidence of bleeding.