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* nbme form 4, block 3
 #470903  
  benu - 12/17/09 13:57
 
 

3.  
A 27-year-old woman is brought to the emergency department 25 minutes after she was involved in a motor vehicle collision. She was the restrained driver. On arrival, she has upper abdominal and left-sided chest pain. Her pulse is 120/min, respirations are 18/min, and blood pressure is 80/50 mm Hg. Examination shows tenderness over the left costal margin and in the left upper quadrant of the abdomen. An x-ray of the chest shows multiple fractures of the ribs. After administration of 2 L of lactated Ringer solution, her pulse is 92/min and her blood pressure increases to 110/80 mm Hg. Her hematocrit is 38%. Which of the following is the most appropriate next step in management?

A

Serial x-rays of the ribs

B

CT scan of the abdomen

C

Contrast angiography

D

Paracentesis

E

Exploratory laparotomy

 
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* Re:nbme form 4, block 3
#1976667
  leowafner - 12/17/09 15:05
 
  Good response to fluid: he become stable
Choice B
 
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* Re:nbme form 4, block 3
#1976671
  benu - 12/17/09 15:08
 
  Would it be B?

E was worng
 
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* Re:nbme form 4, block 3
#1976674
  dr_bubbles - 12/17/09 15:10
 
  yes its B, the pt is stable after fluid resuscitation, do a CT scan to look for the source and solid organ injury.  
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* Re:nbme form 4, block 3
#1976678
  benu - 12/17/09 15:10
 
  thanks!
 
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