hopdoc
Forum Senior
Topics: 14
Posts: 49
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37 yo male brought to the ER after being smashed in a hydraulic press. He is alert and oriented. Despite 10 mg of IV morphine being given by the paramedics he is crying with pain. Pule 110/min, BP 110/70, RR 18/min. Left humeral shaft is fractured, left arm is severely deformed and bent medially at 90 degrees. Decreased radial artery pulse on left side, decresed muscle strength in left forearm. Right leg is shortened and externally rotated. Deformity of right thigh. Pedal pulses are symmetric. Pain on left anterior chest on antero-posterior sternal compression. Breath sounds are normal. Rest of physical exam normal. 2 IV lines have been placed and fractured limbs immobilised. Most appropriate next step in management?
A) X-ray of the left arm, right leg and chest
B) Repeat 10 mg morphine
C) Induction of general anesthesia for operative reduction of the fractures
D) Gentle traction of the left forearm to attempt alignment of the fragments of the humerus
E) Gentle traction of the right leg to attempt alignmnet of the fragments of the femur
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| hopdoc
Forum Senior
Topics: 14
Posts: 49
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nobody? come on...someone take a shot at this!!!
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| an
Forum Guru
Topics: 19
Posts: 437
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B.
not sure, do u have the answer?
good luck with ur exam next week.
___________________
I don't believe in miracles...I rely on them. And sometimes, I create my own.
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| hopdoc
Forum Senior
Topics: 14
Posts: 49
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Ya the answer given is D in UW, but Im not sure if that's correct. Any comments?
And thank you, I really need luck at this point
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| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
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no idea really about the correct answer here.
But hopdoc. I want to give you an advice for your exam. Follow your 1st hunch, thatīs important, you must know it, thatīs the correct answer almost always. Donīt forget it.
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Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
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| hopdoc
Forum Senior
Topics: 14
Posts: 49
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UW says gentle traction when the fracture is displaced and the fragments are obviously pressing on the artery and nerves should be done to take the pressure away from the neurovascular bundle and that will decrease the pain and suffering of the patient. Since no such symptoms in the leg, no need for this in the leg. It takes about 30 secs and if you cannot reduce it in that time, then take straight to the OR.
I had picked B too. Oh well!!!  And thank you chemamr....you are right...most of the times when i change my answer, i change it from correct to incorrect!!!
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