Match each patient's clinical presentation following trauma with the most appropriate next step in diagnosis or management.
- A 32-year-old man presents with a stab wound to zone II of the neck, an expanding pulsatile hematoma, and a muffled voice.Immediate surgical exploration
- A 45-year-old woman involved in a high-speed frontal motor vehicle collision is hemodynamically stable but has a widened mediastinum on an initial portable chest x-ray.Computed tomography angiography of the chest
- A 22-year-old man falls from a 20-foot roof, presenting with a pelvic fracture, a blood pressure of 110/70 mm Hg, and gross blood at the urethral meatus.Retrograde urethrography
- A 55-year-old man is hypotensive (blood pressure 75/40 mm Hg) after a motorcycle crash; primary survey reveals clear breath sounds bilaterally and a positive focused assessment with sonography for trauma (FAST) exam.Exploratory laparotomy
Answer
Proper management requires identifying immediate life threats for operative intervention versus stable presentations requiring further diagnostic imaging.
Each correct pairing strictly follows ATLS guidelines, which prioritize immediate surgical control of hemorrhage for unstable patients and targeted diagnostics for stable patients with specific injury patterns.
Step-by-Step Solution
Key Concept
ATLS Protocols and Next Best Step in Trauma