Your patient is a 21-year-old man with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route, the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should:
A) immediately decompress the left chest and divert to the community hospital for chest tube insertion.
B) immediately decompress the left chest and continue to the trauma center for chest tube insertion.
C) continue to the Level I trauma center for pericardiocentesis.
D) divert to the community hospital for pericardiocentesis.
Question 2
You are assessing and treating a young girl who superficially cut her wrists in a self-stated suicide attempt. Bleeding was not significant and has clotted. While transporting the patient, which one of the following statements is most appropriate?
A) Can you tell me why you tried something like this?
B) This really has upset your parents. How does that make you feel?
C) These cuts are not significant. You didn't really want to do this, did you?
D) I am going to clean these cuts with some water and then wrap them.
A small ecosystem.
On March 25, 1911, as scores of young factory girls leaped to their deaths from the eighth, ninth, a
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