A 37‐year‐old woman presents with a severe, deep, sharp pain in her right hand and forearm. A week before she presented her pain symptoms, she fell on her right forearm and developed mild bruising. She has type-1 diabetes mellitus and is on an insulin treatment. The physical examination reveals that her right hand and forearm were warmer, more swollen, and had a more reddish appearance than the left side. She feels an intense pain upon light touching of her right hand and forearm. Her radial and brachial pulses are palpable. The neurological examination is otherwise normal. The laboratory test results are as follows: Hemoglobin 15.2 g/dL White blood cell count 6,700 cells/cm3 Platelets 300,000 cells/cm3 Alanine aminotransferase 32 units/L Aspartate aminotransferase 38 units/L C-reactive protein 0.4 mg/L Erythrocyte sedimentation rate 7 mm/1st hour The X-ray of the right hand and forearm do not show a fracture. The nerve conduction studies are also within normal limits. What is the most likely diagnosis?
AComplex regional pain syndrome
BCompartment syndrome
CDiabetic neuropathy
DCellulitis
ELimb ischemia
A 37-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He suffered multiple deep lacerations and experienced significant blood loss during transport. In the emergency department, his temperature is 98.6°F (37°C), blood pressure is 102/68 mmHg, pulse is 112/min, and respirations are 22/min. His lacerations are sutured and he is given 2 liters of saline by large bore intravenous lines. Which of the following changes will occur in this patient's cardiac physiology due to this intervention?
AIncreased cardiac output and unchanged right atrial pressure
BDecreased cardiac output and increased right atrial pressure
CIncreased cardiac output and decreased right atrial pressure
DIncreased cardiac output and increased right atrial pressure
EDecreased cardiac output and decreased right atrial pressure
A 27-year-old soldier stationed in Libya sustains a shrapnel injury during an attack, causing a traumatic above-elbow amputation. The resulting arterial bleed is managed with a tourniquet prior to transport to the military treatment facility. On arrival, he is alert and oriented to person, place, and time. His armor and clothing are removed. His pulse is 145/min, respirations are 28/min, and blood pressure is 95/52 mm Hg. Pulmonary examination shows symmetric chest rise. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. There are multiple shrapnel wounds over the upper and lower extremities. A tourniquet is in place around the right upper extremity; the right proximal forearm has been amputated. One large-bore intravenous catheter is placed in the left antecubital fossa. Despite multiple attempts, medical staff is unable to establish additional intravenous access. Which of the following is the most appropriate next step in management?
AIrrigate the shrapnel wounds
BPerform endotracheal intubation
CEstablish intraosseous access
DEstablish central venous access
EReplace the tourniquet with a pressure dressing
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