An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind in the emergency department, her blood pressure is 800 mm Hg, heart rate is 80 beats per minuite, and respiratory rate is 10 breaths per minute. Her GCS score is 14 She complains that her legs feel "funny and won't move tight" however, her spine x-rays do not show a fracture or dislocation A spinal cord injury in thes child

A:

is most likely a central cord syndrome.

must be diagnosed by magnetic resonance imaging

can be excluded by obtaining a CT of the entire spine.

may exist in the absence of objective findings on x-ray studies.

is unlikely because of the incomplete calcification of the vertebral bodies.

SIGNOUT

A.T.L.S.

Q:

A 30-year-old man sustains a severely comminuted, open distal nght femur fracture in a motorcycle crash. The wound is actively bleeding, Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and postenor tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve

A:

immediate angiography.

tamponade of the wound with a pressure dressing.

wound exploration and removal of bony fragments.

realignment of the fracture segments with a traction splint.

fasciotomy of all four compartments in the lower extremity.

A.T.L.S.

५.

A 32-year-old man is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the emergency department, he has no apparent inpury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is unsuccessful. Exammation of his mouth reveals a large hematoma of the pharynx with loss of normal anatomic landmarks Initial management of his airway