A 22-year-old woman at 33 weeks' gestation has abdominal pain and vaginal bleeding after sustaining blunt trauma to the abdomen. Heart rate is 125 bpm, blood pressure is 98/65 mmHg, and respiratory rate is 20/min. Fetal heart rate is 100 bpm. Which of the following is the most appropriate management?
(A) Conservative observation and monitoring if fetal immaturity is seen on ultrasound
(B) Increasing maternal blood pressure with a vasopressor
(C) Infusion of terbutaline
(D) Lumbar epidural anesthesia
(E) Urgent cesarean delivery
E
A 30-year-old man is brought to the emergency department after being rescued from a house fire. With the trachea intubated and FiO2 at 1.0, arterial blood gas values are PaO2 495 mmHg, PaCO2 28 mmHg, and pH 7.28. Hemoglobin saturation measured by co-oximeter is 50%. The most appropriate next step is to
A patient with low cardiac output following coronary artery bypass grafting is transferred to the intensive care unit where a chest roentgenogram confirms proper placement of the pulmonary artery catheter. Serial pulmonary artery occlusion pressures are then measured. Immediately following inflation of the balloon with 1.5 ml of air in the wedged position, brisk bleeding is noted from the endotracheal tube. The most appropriate immediate management is to
(A) withdraw the pulmonary artery catheter
(B) perform endobronchial intubation
(C) apply 15 to 20 cmH20 positive end-expiratory pressure to the airway
(D) administer fresh frozen plasma rapidly
(E) decrease blood pressure rapidly with nitroprusside
B
In a patient with ventricular fibrillation refractory to repeated attempts at defibrillation and epinephrine administration, the most appropriate management is administration of
A 50-year-old patient undergoes subtotal thyroidectomy for Graves' disease. In the immediate postoperative period, he has marked hoarseness but no stridor. The most likely cause of the hoarseness is trauma to the
(A) external branch of the superior laryngeal nerve
(B) internal branch of the superior laryngeal nerve
A 29-year-old man who has been nasotracheally intubated for two weeks following a motor vehicle accident has a fever (39C) and a constant headache. Leukocyte count is 18,000/mm3. The most likely cause is
Evaluation of a postoperative neurologic deficit discloses inability to oppose the thumb and little finger, weakness of abduction of the thumb, and loss of flexion of the distal phalanx of the index finger. This problem is most likely related to
(A) paresthesia occurring during an interscalene brachial plexus block
(B) attempted radial artery cannulation at the wrist
(C) inadequate padding under the elbow
(D) attempted venipuncture in the antecubital fossa
(E) abduction of the upper humerus against an "ether screen"
D
Which of the following attenuates the most common cardiovascular side effect of protamine administration?
(A) Pretreatment with a diuretic
(B) Pretreatment with a prostaglandin inhibitor
(C) Pretreatment with a pulmonary vasodilator
(D) Injection via the distal lumen of the pulmonary artery catheter