Kaplan usmle step 2 pdf
With the open catheter dangling, he takes two steps in the direction of the nurses station, and drops dead. A patient who is receiving total parenteral nutrition through a central venous line becomes frustrated because the nurses are not answering his call button, so he gets up and out of bed, and disconnects his central line from the IV tubing. During the performance of a supraclavicular node biopsy under local anesthesia, suddenly a hissing sound is heard, and the patient drops dead.Ĥ2. Immediate management includes cardiac massage, followed by thoracotomy.Ĥ1. The patient had been hemodynamically stable throughout, but then suddenly goes into cardiac arrest.Ī typical scenario for air embolism, from an injured bronchus to a nearby injured pulmonary vein, and from there to the left ventricle. A patient who sustained a penetrating injury of the chest has been intubated and placed on a respirator, and a chest tube has been placed in the appropriate pleural cavity. A patient who had received a chest tube for a traumatic pneumothorax is noted to be putting out a very large amount of air through the tube (a large air leak), and his collapsed lung is not expanding.Īnother presentation for a major bronchial injury.Ĥ0. Fiberoptic bronchoscopy will confirm diagnosis and level of injury and to secure an airway. That leaves the third (which is the case): traumatic rupture of the trachea or major bronchus.ĭiagnosis is with chest x-ray to confirm the presence of air in the tissues. The second one is tension pneumothorax, but there the alarming findings are all the others already reviewed-the emphysema is barely a footnote. One is rupture of the esophagus, but the setting there is always after endoscopy (for which it is diagnostic). Three things can give thoracic subcutaneous emphysema. Shortly after initial examination it is noted that she is developing progressive subcutaneous emphysema all over her upper chest and lower neck.
She has multiple injuries to her extremities, head trauma, and pneumothorax on the left side. A 34-year-old woman suffers severe blunt trauma in a car accident. Management is emergency surgical repair.ģ8. Classic for traumatic rupture of the aorta: massive trauma, fracture of a hard-to-break bone (could be first rib, scapula, or sternum), and the telltale hint of widened mediastinum.ĭiagnosis is with spiral CT scan. Chest x-ray shows fracture of the left first rib and widened mediastinum. At the ED he is found to be remarkably stable, although he has multiple extremity fractures. As he leaves the ramp at very high speed, his motorcycle turns sideways and he hits the retaining wall at the other end, literally like a rag doll. A motorcycle daredevil attempts to jump over the 12 fountains in front of Caesar’s Palace Hotel in Las Vegas. Management is surgical repair either through the abdomen (more common) or chest dependent on the surgeonģ7. In suspicious cases, laparoscopic evaluation is indicated. You may send an email to for all DMCA / Removal Requests.A nasogastric (NG) tube curling up into the left chest might be an added tidbit. If someone with copyrights wants us to remove this software/Book, please contact us.
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KAPLAN USMLE STEP 2 PDF FREE
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