Did you catch yesterday's test question from the Neurocritical Care Board Review Question Bank? If you answered C, you were right!
The correct answer is right antecubital fossa 18-gauge IV catheter placement (Answer C is correct). Based on Poiseuille’s law, rapid fluid administration is possible when the flow is laminar. Catheters with a larger bore (e.g., 16–18-gauge) and shorter length allow faster infusion rates than a 7-French triple lumen catheter. For this reason, especially in trauma resuscitation, large-bore peripheral IV catheters are favored over triple lumen catheters (Answer B and D are incorrect). In trauma, one should make note of injuries to the extremities when considering placement of an intravascular catheter. This patient has left shoulder and left arm gunshot wounds, which could damage vascular structures, so the left arm should not be used for access. A left antecubital fossa 18-gauge IV catheter would be large enough for the patient's critical needs but is located in the injured arm, therefore, it is not the best option (Answer A is incorrect)
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Q: A 17-year-old man is brought to the emergency department with gunshot wounds to the right flank, left shoulder, left arm, and mid-abdomen. Blood pressure is 60/45 mmHg, pulse is 160/min. His breath sounds are normal. Glasgow Coma Scale score is 13. Head CT is unremarkable.
Which of the following represents the best initial strategy for access to the patient's vascular system? Comment below.
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