Chapter 29 - Chest Injuries

Hemoptysis is defined as: a-coughing up blood. b-abnormal blood clotting. c-blood in the pleural space. d-vomiting blood.

a-coughing up blood.

Which of the following organs or structures does NOT reside within the mediastinum? a-lungs b-trachea c-vena cavae d-esophagus

a-lungs

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should: a-administer oxygen and transport to the hospital. b-circumferentially tape a dressing around his chest. c-immediately perform a rapid head-to-toe exam. d-recognize that he needs a needle decompression.

a-administer oxygen and transport to the hospital.

The ________ nerves control the diaphragm. a-phrenic b-costal c-intercostal d-vagus

a-phrenic

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called: a-pleurisy. b-pneumonitis. c-dyspnea. d-pneumothorax.

a-pleurisy.

Very young children tend to breathe predominantly with their diaphragm because: a-their chest wall and ribs are very pliable. b-they require less tidal volume per breath. c-there is no nerve innervation of the intercostal muscles. d-their intercostal muscles are not fully developed.

d-their intercostal muscles are not fully developed.

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade? a-engorged jugular veins b-diminished breath sounds c-widening pulse pressure d-a rapid, irregular pulse

a-engorged jugular veins

You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should: a-immediately request ALS support. b-insert an oropharyngeal airway. c-obtain a set of baseline vital signs. d-perform a focused secondary exam.

a-immediately request ALS support.

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged: a-minute volume will decrease. b-excess carbon dioxide will be eliminated. c-minute volume will remain unchanged. d-minute volume will increase.

a-minute volume will decrease.

When assessing a patient with a hemothorax, you will MOST likely find: a-signs and symptoms of shock. b-distant or muffled heart tones. c-ipsilateral tracheal deviation. d-jugular venous engorgement.

a-signs and symptoms of shock.

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of: a-traumatic aortic rupture. b-penetrating lung injuries. c-a massive cardiac contusion. d-a tension pneumothorax.

a-traumatic aortic rupture.

A flail chest occurs when: a-multiple ribs are fractured on both sides of the thoracic cage. b-a segment of the chest wall is detached from the thoracic cage. c-more than three ribs are fractured on the same side of the chest. d-a segment of fractured ribs bulges during the inhalation phase.

b-a segment of the chest wall is detached from the thoracic cage.

You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient's deterioration? a-a total collapse of the affected lung b-compression of the aorta and vena cava c-hidden bleeding in the thoracic cavity d-blood accumulation in the pleural space

b-compression of the aorta and vena cava

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unconscious, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a: a-tension pneumothorax. b-laceration of the aorta. c-massive hemothorax. d-pericardial tamponade.

b-laceration of the aorta.

A spinal cord injury at the level of C7 would MOST likely result in: a-paralysis of the diaphragm. b-paralysis of the intercostal muscles. c-paralysis of all the respiratory muscles. d-immediate cardiac arrest.

b-paralysis of the intercostal muscles.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should: a-apply 100% oxygen and immediately transport. b-provide some form of positive-pressure ventilation. c-perform a rapid head-to-toe physical assessment. d-place her supine and elevate her lower extremities.

b-provide some form of positive-pressure ventilation.

During your assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should: a-request a paramedic to decompress the chest. b-stabilize the chest wall with a bulky dressing. c-make note of it and continue your assessment. d-reassess the adequacy of the patient's breathing.

b-stabilize the chest wall with a bulky dressing.

An open pneumothorax occurs when: a-air enters the pleural space from a perforated lung. b-extreme pleural pressure causes the lung to rupture. c-air enters the pleural space from outside the body. d-a fractured rib perforates the tissue of the lung.

c-air enters the pleural space from outside the body.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT: a-profound cyanosis. b-unilaterally absent breath sounds. c-collapsed jugular veins. d-bulging intercostal muscles.

c-collapsed jugular veins.

The thoracic cavity is separated from the abdominal cavity by the: a-anterior rib cage. b-costovertebral angle. c-diaphragm. d-intercostal margin.

c-diaphragm.

A spontaneous pneumothorax would MOST likely occur as the result of: a-excessive coughing in a patient with pneumonitis. b-blunt or penetrating trauma to the anterior chest wall. c-exertion of a person with a congenital lung defect. d-abnormally slow breathing in a patient with pleurisy.

c-exertion of a person with a congenital lung defect.

When a person is lying supine at the end of exhalation, the diaphragm: a-descends below the level of the navel. b-is less prone to penetrating trauma. c-may rise as high as the nipple line. d-contracts and flattens inferiorly.

c-may rise as high as the nipple line.

You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should: a-begin ventilatory assistance. b-call for a paramedic ambulance. c-partially remove the dressing. d-begin rapid transport at once.

c-partially remove the dressing.

The phrenic nerves control the diaphragm and exit the spinal cord at: a-C1 and C2. b-C1, C2, and C3. c-C3 and C4. d-C3, C4, and C5.

d-C3, C4, and C5.

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should: a-suspect a severe hemopneumothorax. b-perform a secondary assessment. c-request a paramedic ambulance. d-aggressively manage his airway.

d-aggressively manage his airway.

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a: a-myocardial contusion. b-flail chest. c-cardiac tamponade. d-pneumothorax.

d-pneumothorax.

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to applying 100% oxygen, you should: a-determine if he has cardiac problems. b-apply bulky dressings to the sternum. c-apply an automated external defibrillator (AED) and take his blood pressure. d-prepare for immediate transport.

d-prepare for immediate transport.

A patient who presents with profound cyanosis following a chest injury: a-has most likely experienced a ruptured aorta. b-is most likely experiencing severe blood loss. c-should be placed in Trendelenburg's position. d-requires prompt ventilation and oxygenation.

d-requires prompt ventilation and oxygenation.

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred? a-fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia b-asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta c-collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest d-ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

d-ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

Pleural fluid is contained between the: a-parietal pleura and the chest wall. b-parietal pleura and the heart. c-visceral pleura and the lung. d-visceral and parietal pleurae.

d-visceral and parietal pleurae.