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17410 Medicine

A young motorist suffered injuries in a major road traffic accident. He was diagnosed to have a fracture of the left femur and left humerus. He was also having fractures of multiple ribs anteriorly on both the sides. In the examination, the blood pressure was 80/ 60 mm Hg. and heart rate was 140/minute. The patient was agitated, restless, and tachypneic. Jugular veins were distended. Air entry was adequate in both the lung fields. Heart sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt. On a priority basis, the immediate intervention would be –

ARapid blood transfusion.
BUrgent pericardial tap.
CIntercostal tube drainage on both the sides.
DFixation of left femur and repair of femoral artery.
Medicine
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17411 Medicine

A 50-year-old woman is brought to the emergency department unconscious following a motor vehicle accident. She is placed on telemetry to monitor her vitals continuously, and she remains hypotensive despite receiving a bolus of fluids and being placed on IV fluids. She regains consciousness and her pulse is 180/mm. Her ECG shows regularly spaced narrow, QRS complexes. No P wave is visible in most leads, but there is a small downward deflection immediately following QRS complexes in lead II. A carotid massage is performed, and her pulse is reduced to 80/rn in. Stimulation of the afferent fibres in which of the following nerves most likely resulted in the favourable response observed?

ACardiac sympathetic nerves
BCarotid sympathetic nerves
CGlossopharyngeal nerve
DHypoglossal nerve
Medicine
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