Rationales from the Nov. 6 Email

QUESTION ONE: The correct answer is B. Uneven heights of the iliac crest are a frequent finding with pelvic fractures. Pelvic fractures are frequently associated with hypovolemia, which would cause symptoms such as hypotension with a narrowed pulse pressure, diaphoretic skin and tachycardia (rather than bradycardia). Subcutaneous emphysema is associated with air under the skin, which is not a common finding after a pelvic fracture. Bruising around the umbilicus is associated with retroperitoneal bleeding or liver injury, none of which is directly associated with pelvic fractures.

QUESTION TWO: The correct answer is C. Patients with blunt cardiac injuries frequently develop right ventricular failure which can cause hypotension. This may be treated with positive inotropic drugs such as dobutamine. Positive inotropic drugs are contraindicated in patients with aortic injuries. In fact, beta-blockers are often used in the treatment of these injuries. Even post-operatively, aortic injuries are frequently hypertensive and a positive inotrope would not be indicated. Patients with pelvic fractures and placental abruption tend to be hypovolemic and treatment would include fluid administration as opposed to a positive inotropic drug.

QUESTION THREE: The correct answer is B. The appropriate placement for a needle decompression is the second intercostal space between ribs two and three. Because bundles of nerves and blood vessels run below ribs, the decompression should be accomplished directly above the lower rib, in this case, the third rib. If tracheal deviation occurs, it will deviate AWAY from the tension pneumothorax, so the needle decompression should occur on the opposite side as tracheal deviation.