QUESTION 4:
A 22-year-old male is brought to the emergency department by ambulance following a fall approximately 25 feet onto rocks while rock climbing. He arrives on a spine board with a cervical collar in place, intubated and ventilated, and one 14 Ga. IV with crystalloids running. There are bruises and abrasions along the right side of his body. There is a flail segment on the right rib cage which has been stabilized by the EMS crew. Lungs sounds are equal and clear. The abdomen is soft and without guarding. The pelvis "gives" a little with inward pressure. Downward pressure and pressure over the symphysis pubis were deferred. GCS 4, BP 84/56, HR 134, SpO2 94% with oxygen, ETCO2 40 mmHg, Temp. 35.4/95.7. Which five interventions are most likely to effectively address the patient's shock?
Begin a second large bore IV.
Transfuse warmed type-O blood.
Infuse 3000 mL of warmed crystalloid with a pressure bag.
Apply a powered warm air blanket.
Arrange for immediate transfer to a higher-level trauma center.
Obtain a pelvic x-ray.
Obtain laboratory studies for hemoglobin, hematocrit, and lactate.
Apply a pelvic binder.
Remove the spine board.
