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Question 1: A 23-year-old male was hit in the anterior aspect of the neck with a bat. He has ecchymosis and edema of the anterior aspect of the neck. The thyroid cartilage is tender to palpation and there is crepitus with palpation. There are no external lacerations. The patient has worsening hoarseness and increasing stridor. What is the next step in management of this patient?

 

  1. CT of the neck with and without contrast

  2. Carotid arteriogram

  3. Chest x-ray

  4. Closed reduction of a suspected thyroid cartilage fracture in the ED

  5. To the OR to secure the airway and perform direct laryngoscopy

 

Reference: Roland, PS. Chapter 3. Blunt Neck Trauma. Otolaryngology Clinical Case Studies. 1st ed. Columbus, OH: Anadem Publishing, Inc.; 2007.

 

Question 2: A 6-month-old baby boy is brought in by his mother for a dog bite. She says the boy was lying on a blanket in the living room when the family dog just ran up and bit him on the arm. The child has no PMH. Vitals are normal upon arrival. Upon exam, you see this. What should you do for this patient?

 

  1. Treat with amoxicillin-clavulanate and discharge

  2. Report this to child protective services

  3. Cleanse the area and reassure the mother

  4. Order a CBC, blood, and wound cultures

  5. X-ray the left humerus

 

References: Schwab RA, Powers RD. Chapter 50. Puncture Wounds and Bites. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Shapiro RA, Schubert CJ, Makoroff KL, McGraw ML. Chapter 15. Child Abuse. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. eds. The Atlas of Emergency Medicine, 3e. New York, NY: McGraw-Hill; 2010.



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