A young man sustains a gunshot wound to the base of his neck. He was shot point blank with a .38 caliber revolver. The entrance wound is above the left clavicle, below the level of the cricoid cartilage, and just lateral to the sternomastoid muscle. The exit wound is just above the spinous process of the right scapula. He has normal breath sounds on both sides, is awake and alert, is talking with a normal tone of voice, is neurologically intact, and is hemodynamically stable. Portable x-ray films of the neck and chest took in the emergency department showed some air in the tissues of the lower neck, but are otherwise non-diagnostic. Which of the following is the most appropriate next step in management?
A. Observation for several hours
B. CT scan of the lower neck and upper chest
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
D. Immediate surgical exploration of the lower neck through a collar incision
E. Immediate surgical exploration of the upper chest through a median sternotomy

C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration

Explanation:

Based on the information being provided in regards to the scenario at hand it can be said that the most appropriate next steps would be to first conduct an angiogram in order to determine if the heart was affected and to what degree. After this procedure, three more procedures need to be conducted in order to determine if any other organs were affected before actually going into surgery. These procedures would be esophagogram, esophagoscopy and bronchoscopy. Therefore the answer to this question would be C.

these are common warning signs of overtraining syndrome:

washed-out feeling, tired, drained, lack of energy

mild leg soreness, general aches, and pains

pain in muscles and joints

sudden drop in performance

insomnia

headaches

decreased immunity (increased number of colds, and sore throats)

decrease in training capacity/intensity

moodiness and irritability

depression

loss of enthusiasm for the sport

decreased appetite

increased incidence of injuries.

a compulsive need to exercise

the answer is b its not mature