You are caring for a man who had his arm mangled by a piece of farm equipment. Bleeding has been controlled with a tourniquet; however, the patient is hypotensive and tachycardic. He has an extensive cardiac history and takes Pradaxa. There is a community hospital 18 minutes away by ground, a level III trauma center 40 minutes away by ground, and a level I trauma center 30 minutes away by air. You should:
A) transport to the community ER so he can receive a blood transfusion.
B) transport by ground to the level III facility, as they have the resources to stabilize the patient.
C) call for air transport to the higher-level trauma center.
D) call for air transport, but tell them to fly to the level III trauma center, as it is closer.
Question 2
Firefighters have pulled a middle-aged male from a burning bedroom. The patient is unresponsive and has obvious deformity of his left ankle. His respirations are rapid, stridorous, and shallow. Your partner inserts an oropharyngeal airway and begins ventilating the patient with a bag-valve mask. Which one of the following actions would you perform next?
A) Instruct your partner to hyperventilate the patient.
B) Find out how long the patient was in the burning structure.
C) Check the patient's breath sounds.
D) Assess the patient's carotid pulse.
A farm family in Custer, Nebraska, in 1888, a region where Populist sentiment was strong.
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