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100% oxygen
18%
3/17
Emergency open fracture repair
41%
7/17
Exploratory laparoscopy
6%
1/17
Intubation
Packed red blood cells
24%
4/17
Select Answer to see Preferred Response
This patient has an altered level of consciousness with a Glascow Coma Scale (GCS) score of 7 (eyes - 1, motor - 4, and verbal - 2), putting him at risk for loss of airway. Given the patient's inability to protect his airway, he must be immediately intubated. The most important first step in evaluating and treating a trauma patient is the primary survey. The primary survey includes evaluation of the patient’s airway, breathing, circulatory status, disability/neurologic status, and exposure/environmental control (A, B, C, D, and E). The primary survey is meant to identify and treat life-threatening injuries in the acute trauma patient. The GCS is used in trauma to determine the patient's level of consciousness and includes evaluation of eye opening, verbal response, and motor response to various levels of stimulation. A GCS score of less than 8 indicates a patient who is unable to adequately maintain their airway thus warranting immediate intubation. Incorrect Answers: Answer 1: 100% oxygen is inappropriate as this patient's oxygen saturation is normal and the concern is that he cannot protect his airway. It is true that preoxygenation occurs prior to intubation; however, 100% oxygen by itself is insufficient management. Answer 2: Emergency open fracture repair is incorrect as this patient's most immediate need is to protect their airway. Subsequently, a radiograph to confirm tube placement, ventilation, and IVs and blood product resuscitation followed by transfer to the operating room would be the order of management. Answer 3: Exploratory laparoscopy would be indicated after the patient is successfully intubated and ventilated as management of their circulation (along with IV placement and a massive transfusion protocol). Answer 5: Packed red blood cells and a massive transfusion protocol are part of evaluating this patient's circulation and would take place after a definitive airway has been placed. Bullet Summary: The management of a patient in a trauma resuscitation in order is 1. Airway 2. Breathing, and 3. Circulation.
4.3
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