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  #1  
Old 07-09-2012
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Emergency Ambulatory Managment of Head Trauma

A 13-year-old male falls 10 feet off a ladder. He is immobilized and intubated at the scene by emergency medical services secondary to altered mental status. A physician staffed aeromedical helicopter lands to transport the child to a level one trauma center. His vital signs taken in the helicopter are pulse 70 beats/min, respiratory rate 16/min, blood pressure 117/66 mm Hg, oxygen saturation 95% on Fi02 of 100%. Physical examination shows a palpable, soft, depressible hematoma on the back of the child's head. Pupils are 5 mm and slow to react. There are no long bone deformities and his abdomen is soft. It is imperative that during the flight both hypotension and what other physiologic abnormality should be avoided?

A. Bradycardia
B. Hypertension
C. Hypocarbia
D. Hypoxia
E. Tachycardia
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  #2  
Old 07-10-2012
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ans hypocarbia ... correct me if im wrong
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Old 07-10-2012
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hypocarbia i think so because it cause vasospasm of brain vessels which could lead to further impairment in blood supply against the inc. ICP....i am not sure that what i guess .... thanks
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Old 07-10-2012
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D. Hypoxia
yes in step 1 we learn that low carbon dioxide causes vasospasm.

but i remember fischer saying that much more important than CO2 .... is O2.

CO2 MIGHT decrease the bleed somewhat. (it is not absolute)
but decreased O2 will cause permanent cell death for SURE.

hence the answer.
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Old 07-10-2012
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Hypoxia, the brain cells are already under stress, edema is or will follow shortly, any O2 decrease will screw this kid.
Also lets get rdy for some diabetes insipidus!
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