Chapter 29, EMT Chapter 29: Chest Injuries

The phrenic nerves control the diaphragm and exit the spinal cord at:

C3, C4, and C5

Distending jugular veins, a narrowing pulse pressure, and muffled heart sounds are seen in which of the following conditions?

Cardiac tamponade

Which of the following is NOT a sign or symptom of a chest injury?

Clear and equal breath sounds

You respond to the local rodeo arena for a bull rider. The scene is safe, and the patient is lying unconscious in the middle of the arena. His airway is open, and he is breathing 20 breaths/min and blood pressure is 110/64 mm Hg. There is no obvious bleeding. Bystanders tell you he was thrown into the air and landed on the bull's head. He was not wearing a vest. Which of the following is NOT indicated in blunt trauma to the chest.

Dissection of the carotid arteries

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?

Engorged jugular veins

Which of the following regarding hemothorax is correct?

It can only be treated by a surgeon

Which of the following organs or structures does NOT reside within the mediastinum?

Lungs

Which of the following is NOT a pertinent negative to note during your assessment of a patient with chest trauma?

No heart murmurs

_____ can increase intrathoracic pressure reducing cardiac output and potentially worsening injuries such as pneumothorax.

Overventilation

You respond to a motor vehicle collision and find a 29-year-old woman who is complaining of chest pain. Her chest struck the steering wheel. her airway is open, she is breathing at 24 breaths/min and she is coughing up blood. Her pulse is 130 beats/min, rapid and weak, and her BP is 90/58 mm HG. You notice cyanosis around the lips and note that her fingers are also blue. When you expose the chest, she tells you it hurts and points to a bruised spot. Which of the following is a symptom

Pain at the site of injury

On inhalation, which of the following does NOT occur?

The pressure inside the chest increases.

A flail chest occurs when:

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

While jogging, a 19 year old male experienced an acute onset 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:

administer oxygen and transport to the hospital

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:

aggressively manage his airway.

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

A sucking chest wound should be treated with:

an occlusive dressing

Which of the following is most likely to cause immediate death?

aortic rupture

During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should:

assist ventilations with a bag-valve mask.

Closed chest injuries are typically caused by ________?

blunt trauma

The trachea divides into the right and left main stem ____

bronchi

You respond to an 18-year-old man who has been assaulted with a baseball bat. He was hit in the chest. He is unresponsive, apneic, and pulseless. This condition is most likely related to:

commotio cordis

During inhalation, the pressure in the chest ______.

decreases

The ____ separates the thoracic cavity from the abdominal cavity

diaphragm

The thoracic cavity is separated from the abdominal cavity by the:

diaphram

Large blood vessels in the chest that can result in massive hemorrhaging include all of the following EXCEPT:

femoral arteries

Common signs and symptoms of tension pneumothorax include all of the following EXCEPT:

high blood pressure

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 breath sounds. As your partner is supporting her ventilations, you should:

immediately request ALS support

Traumatic asphyxia:

is a sudden, severe compression of the chest

A simple pneumothorax:

is commonly caused by blunt chest trauma

You arrive at the scene of a major motor vehicle crash. The patient, a 50 year old female, was removed form her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive, 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:

laceration of the aorta

When a person is lying supine at the end of exhalation, the diaphragm:

may rise as high as the nipple line

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

must increase his or her respiratory rate to maintain adequate minute volume.

A _____ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms.

myocardial contusion

A spinal cord injury at the level of C7 would MOST likely result in:

paralysis of the intercostal muscles

The ____ lines the inner chest wall.

parietal pleura

You have sealed the open chest wound of a 40 year old male who was stabbed in the anterior chest. Your assessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing.

The ________ nerves control the diaphragm.

phrenic

A _____ results when an injury allows air to enter through a hole in the chest wall or the surface of the lung as the patient attempts to breathe, causing the lung on that side to collapse.

pneumothorax

In order to avoid exacerbating a patients injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:

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 providing supplemental oxygen, you should:

prepare for immediate transport

Immediately life-threatening chest injuries must be found and managed during the _________?

primary assessment

A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturations is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:

pulmonary contusion

A patient who presents with profound cyanosis following a chest injury:

requires prompt ventilation and oxygenation.

A patient with blunt trauma who is holding the lateral side of his chest and has rapid and shallow respirations is most likely suffering from:

rib fractures

You respond to a 20-year-old man who was playing basketball and suddenly developed chest pain and respiratory difficulty. He is alert and oriented and complaining of chest pain. He is breathing at 24 breaths/min. His pulse is 140 beats/min and BP is 160/90 mm Hg. When listening to the chest, you notice diminished breath sounds on the left side. This patient is most likely suffering from a

simple pneumothorax

Patients with chest injuries will often present with _______?

tachypnea

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

Children are often "belly breathers" because _________?

their intercostal muscles are not developed

Air is supplied to the lungs via the:

trachea

Paradoxical motion of the chest refers to:

unequal expansion of the chest wall

Pleural fluid is contained between the:

visceral and parietal pleurae.