Match each clinical trauma presentation with the most appropriate next step in definitive diagnosis or management.
- 35-year-old male with a stab wound to Zone II of the neck, presenting with an expanding pulsatile hematoma and stridor.Immediate surgical exploration
- 45-year-old male in hemorrhagic shock following a motorcycle collision. FAST is negative, CXR is clear, and he remains hypotensive despite a pelvic binder and blood transfusion.Pelvic angiography with embolization
- 50-year-old male after a high-speed motor vehicle collision with unequal upper extremity blood pressures. He is hemodynamically stable with a widened mediastinum on chest X-ray.Computed tomography angiography of the chest
- 22-year-old male with a severe crush injury to the pelvis. Physical examination reveals blood at the urethral meatus and a high-riding prostate on digital rectal examination.Retrograde urethrography
Answer
Stab wound with hard signs matches with immediate surgical exploration; unstable pelvic fracture with negative FAST matches with pelvic angiography with embolization; stable patient with widened mediastinum matches with CT angiography of the chest; pelvic injury with meatal blood matches with retrograde urethrography.
Each presentation maps to a specific therapeutic or diagnostic pathway: hard signs in neck trauma dictate surgery; unstable pelvic bleeding without an intraperitoneal source requires angiography; stable blunt aortic injury requires CT angiography; and signs of urethral injury mandate retrograde urethrography prior to any catheterization attempt.
Step-by-Step Solution
Key Concept
Algorithms for acute trauma management based on mechanism of injury, anatomic location, and hemodynamic stability.