1. The primary indication for transferring a  patient to a higher level trauma center is: unavailability of a surgeon or operating room  staff. multiple system injuries, including severe  head injury. resource limitations as determined by the  transferring doctor. resource limitations as determined by the  hospital administration. widened mediastinum on chest x-ray  following blunt thoracic trauma. 2. teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her  blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8  breaths per minute, and GCS score is 6. The first step in managing this patient is to: obtain a lateral cervical spine x-ray.  insert a central venous pressure line.  administer 2 liters of crystalloid solution.  perform endotracheal intubation and  ventilation. apply the PASG and inflate the leg  compartments. 3. Contraindication to nasogastric intubation is the presence of a: gastric perforation.  diaphragmatic rupture.  open depressed skull fracture.  fracture of the cervical spine.  fracture of the cribriform plate.  4. Which one of the following statements regarding patients with thoracic spine injuries is TRUE? Log-rolling may be destabilizing to  fractures from T-12 to L-1. Adequate immobilization can be  accomplished with the scoop stretcher. Spinal cord injury below T-10 usually spares  bowel and bladder function. Hyperflexion fractures in the upper  thoracic spine are inherently unstable. These patients rarely present with spinal  shock in association with cord injury. 5. young man sustains a ritle wound to the midabdomen. He is brought promptly to the emergency department by prehospital  personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate step is to perform: a celiotomy.  an abdominal CT scan.  diagnostic laparoscopy.  abdominal ultrasonography.  a diagnostic peritoneal lavage.  6. young woman sustains a severe head injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her  blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: administer an osmotic diuretic.  prevent secondary brain injury. 