A 45-year-old man is brought to the emergency department after a car accident with pain in the middle of his chest and some shortness of breath. He has sustained injuries to his right arm and leg. He did not lose consciousness. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 18/min, and blood pressure is 90/60 mm Hg. He is alert and oriented to person, place, and time. Examination shows several injuries to the upper extremities and chest. There are jugular venous pulsations 10 cm above the sternal angle. Heart sounds are faint on cardiac examination. The lungs are clear to auscultation. An ECG is shown. Which of the following is the most appropriate next step in management?
AContrast-enhanced CT angiography
BTransthoracic echocardiography
CX-ray of the chest
DCT scan of the brain
EContrast esophagram with gastrografin
A 56-year-old man is brought to the emergency department 25 minutes after he was involved in a high-speed motor vehicle collision where he was the unrestrained passenger. He has severe lower abdominal and pelvic pain. On arrival, he is alert and oriented. His pulse is 95/min, respirations are 22/min, and blood pressure is 106/62 mm Hg. Examination shows severe tenderness to palpation over the lower abdomen and over the left anterior superior iliac spine. There is no limb length discrepancy. Application of downward pressure over the pelvis shows no springy resistance or instability. Rectal examination is unremarkable. A focused assessment with sonography shows no free fluid in the abdomen. There is no blood at the urethral meatus. Placement of a Foley catheter shows gross hematuria. An x-ray of the pelvis shows a fracture of the left pelvic edge. Which of the following is the most appropriate next step in management?
AIntravenous pyelography
BExternal fixation of the pelvis
CCystoscopy
DRetrograde urethrography
ERetrograde cystography
A 67-year-old woman has fallen from the second story level of her home while hanging laundry. She was brought to the emergency department immediately and presented with severe abdominal pain. The patient is anxious, and her hands and feet feel very cold to the touch. There is no evidence of bone fractures, superficial skin wounds, or a foreign body penetration. Her blood pressure is 102/67 mm Hg, respirations are 19/min, pulse is 87/min, and temperature is 36.7°C (98.0°F). Her abdominal exam reveals rigidity and severe tenderness. A Foley catheter and nasogastric tube are inserted. The central venous pressure (CVP) is 5 cm H2O. The medical history is significant for hypertension. Which of the following is best indicated for the evaluation of this patient?
AX-Ray
BUltrasound
CPeritoneal lavage
DCT scan
EDiagnostic laparotomy
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