Chest Injuries Ch 29

the left lung has ___ lobes

2

Pneumothorax is defined as:

accumulation of air in the pleural space

a dressing made of vaseline- impregnated gauze, aluminum foil or plastic that protects a wound from air and bacteria

occlusive dressing

an injury to the chest in which the chest wall itself is penetrated by a fractured rib or more frequently, by an external object such as a bullet or knife

open chest injury

you may find a decrease in breath sounds on the affected side, however it is important to note that it takes a loss of greater than ___% of the lung surface to be able to hear this decrease

40

the average tidal volume for a male is approximately ____mL

500

Subcutaneous emphysema is an indication that:

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

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

C3, C4, and C5.

the average bag mask device consists of a self inflating bag contains

1000 to 1500 mL of air

the ventricular fibrillation responds positively to early defibrillation if provided within the first ____ min after the injury

2

the heart muscle is unique in that it needs to be stretched to create a good contraction to pump blood out of the ventricles

Frank starling mechanism

A one way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve

flutter valve

A bruise of the heart muscle

myocardial contusion

nerves supplying the diaphragm , exit the spinal cord at c3, c4, and c5

phrenic nerves

thin membrane covers each of the lungs and the thoracic cavity

pleura

Immediately life-threatening chest injuries must be found and managed during the _______.

primary assessment

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

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.

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

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:

Immediately request ALS support.

A weakening in the wall of the aorta is known as _______.

an aneurysm.

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

aortic rupture

distended or engorged jugular veins seen on both sides of the trachea , narrowing pulse pressure, muffled heart sounds

becks triad

in patients who have sustained a spinal cord injury in the intercostal muscles , it is important for you to note that the patients may be unable to move these muscles and will have to breath entirely with the diaphragm

belly breathing

Closed chest injuries are typically caused by _______.

blunt trauma.

Patients with rib fractures will commonly:

breathe rapidly and shallowly.

patients with spinal cord injuries at ____ or above can lose their ability to breath entirely

c3

a patient whose spinal cord is injured below the _____ level will lose the power to move the intercostal muscles but the diaphragm will still contract. The patient will still be able to breath because the phrenic nerves remain intact

c5

compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output

cardiac tamponade (pericardial tamponade)

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

collapsed jugular veins

A blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a person's heartbeat

commotio cordis

air escaping from a lacerated lung is leaking into the chest wall

crepitus or subcutaneous emphysema

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

runs through the back of the chest connecting the pharynx above with the stomach and the abdomen below

esophagus

the accumluation of blood and air in the pleural space of the chest

hemopneumothorax

the spitting or coughing up blood

hemoptysis

a collection of blood in the pleural cavity

hemothorax

The MOST critical treatment for a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space

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

the esophagus, trachea, and great vessels lie in a specific cavity or space centrally located in the thorax

mediastinum

if you multiply the tidal volume by the number of breaths/min is called:

minute ventilation or minute volume

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 rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

myocardial contusion.

lying close to each rib along the bottom or interior and slightly posterior to the lowest margin of each rib ,composed of a network of nerves , arteries and veins is the:

neurovascular bundle

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

Injury or bruising of lung tissue that results in hemorrhage

pulmonary contusion

monitors the oxygen saturation of hemoglobin by directing a beam of an area between two probes.

pulse oximetry

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

requires prompt ventilation and oxygenation

The exchange of oxygen and carbon dioxide in the alveoli is _______.

respiration

an open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound

sucking chest wound

small amount of fluid, which allows the lungs to move freely against the inner chest wall as a person breathes

surfactant

Patients with chest injuries will often present with _______.

tachypnea

a life-threatening collection of air within the pleural space; the volume and pressure have both collapsed the involved lung and caused a shift of the mediastinal structures to the opposite side

tension pneumothorax

occurs more commonly as a result of closed , blunt injury to the chest in which a fractured rib lacerates a lung or bronchus

tension pneumothorax

Pleural fluid is contained between the:

visceral and parietal pleurae.

the right lung has __ lobes

3

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?

Compression of the aorta and vena cava.

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?

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

a condition in which two or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage

flail chest

Common signs and symptoms of a chest injury include all of the following, EXCEPT:

hematemesis.

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will decrease

an open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound

open pneumothorax

in normal circumstances the hemoglobin is saturated with oxygen and the number of represents the percentage of

oxygen saturation (sao2)

the motion of the portion of the chest wall that is detached in a flail chest; the motion (in during inhalation, out during exhalation) is exactly the opposite of normal chest wall motion during breathing

paradoxical motion

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

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:

partially remove the dressing.

The fibrous sac that surrounds the heart

pericardium

irritation of or damage to the pleural surfaces causes a characteristic sharp or sticking pain with each breath when these normally smooth surfaces slide on one another

pleuritic pain or pleurisy

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

any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient

simple pneumothorax

a pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space

spontaneous pneumothorax

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:

stabilize the chest wall with a bulky dressing

Children are often "belly breathers" because _________?

their intercostal muscles are not developed

contains the heart and the great vessels: aorta, the right and left subclavian arteries and their branches , the pulmonary arteries and the superior and inferior vena cavae

thoracic cage

lies in the middle of the neck, divides into the left and right mainstream bronchi and supply air to the lungs

trachea

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

traumatic aortic rupture.