Chapter 30- Chest Injuries

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? Widening pulse pressure A rapid, irregular pulse Engorged jugular veins Diminished breath sounds

Engorged jugular veins

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? Collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest Asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle Fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia

Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

Subcutaneous emphysema is an indication that: blood is slowly accumulating within the tissue of the lung. at least half of one lung has completely collapsed. air is escaping into the chest wall from a damaged lung. your patient is experiencing a pericardial tamponade.

air is escaping into the chest wall from a damaged lung.

An open pneumothorax is: an open chest wound through which air moves during breathing. a fractured rib that perforates the tissue of the lung surface. extreme pleural pressure that causes the lung to rupture. the entry of air into the pleural space from a perforated lung.

an open chest wound through which air moves during breathing.

Signs and symptoms of a tension pneumothorax include all of the following, except: unilaterally absent breath sounds. profound cyanosis. altered mental status. collapsed jugular veins.

collapsed jugular veins.

Hemoptysis is defined as: coughing up blood. blood in the pleural space. abnormal blood clotting. vomiting blood.

coughing up blood.

Common signs and symptoms of a chest injury include all of the following, except: hematemesis. tachypnea. chest wall ecchymosis. localized pain.

hematemesis.

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: obtain a set of baseline vital signs. immediately request ALS support. perform a focused secondary exam. insert an oropharyngeal airway.

immediately request ALS support.

The most critical treatment for a tension pneumothorax involves: surgically removing the portion of the lung that is damaged. placing a bulky dressing over the affected side of the chest. inserting a needle through the rib cage into the pleural space. assisting the patient's breathing with increased tidal volume.

inserting a needle through the rib cage into the pleural space.

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 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: massive hemothorax. laceration of the aorta. tension pneumothorax.

laceration of the aorta.

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

might rise as high as the nipple line.

A rapid, irregular pulse following blunt trauma to the chest is most suggestive of a: pericardial tamponade. tension pneumothorax. myocardial contusion. ruptured aorta.

myocardial contusion.

A spinal cord injury at the level of C7 would most likely result in: paralysis of all the respiratory muscles. immediate cardiac arrest. paralysis of the intercostal muscles. paralysis of the diaphragm.

paralysis of the intercostal muscles.

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: begin rapid transport at once. partially remove the dressing. call for a paramedic ambulance. begin ventilatory assistance.

partially remove the dressing.

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

pneumothorax.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, shallow breathing, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should: perform a rapid head-to-toe physical assessment. provide ventilation assistance with a bag valve mask. apply 100% oxygen via a nonrebreathing mask. place her supine and elevate her lower extremities.

provide ventilation assistance with a bag valve mask.

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 saturation is 78%. His breath sounds are equal bilaterally, and his jugular veins are normal. You should suspect: traumatic asphyxia. tension pneumothorax. pulmonary contusion. massive hemothorax.

pulmonary contusion.

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

signs and symptoms of shock.

Elevation of the rib cage during inhalation occurs when: abdominal contents descend. intrathoracic pressure decreases. the intercostal muscles contract. the diaphragm descends.

the intercostal muscles contract.

Pleural fluid is contained between the: visceral pleura and the lung. visceral and parietal pleurae. parietal pleura and the chest wall. parietal pleura and the heart.

visceral and parietal pleurae.