EMT Ch. 30: Chest Injuries STUDY SET

Commotio Cordis

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.

flail chest

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.

crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

flutter valve

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.

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

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

Pneumothorax is defined as: A. accumulation of air in the pleural space B. blood collection within the pleural space C. blood collection within lung tissue D. accumulation of air between the lungs

A. accumulation of air in the pleural space

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

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

The thoracic cavity is separated from the abdominal cavity by the: A. diaphragm B. costovertebral angle C. intercostal margin D. anterior rib cage

A. diaphragm

The _____ nerves supply the diaphragm. A. phrenic B. costal C. intercostal D. vagus

A. phrenic

occlusive dressing

An airtight dressing that protects a wound from air and bacteria; a commercial vented version allows air to passively escape from the chest, while an unvented dressing may be made of petroleum jelly-based (Vaseline) gauze, aluminum foil, or plastic.

open chest injury

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.

closed chest injury

An injury to the chest in which the skin is not broken, usually caused by blunt trauma.

open pneumothorax

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.

When the chest impacts the steering wheel during a motor vehicle crash with rapid deceleration, the resulting injury that kills almost one third of patients, usually within seconds, is: A. a hemothorax. B. aortic shearing. C. a pneumothorax. D. a ruptured myocardium.

B. aortic shearing

Patients with rib fractures will commonly: A. prefer to lie in a supine position B. breathe rapidly and shallowly C. develop a sucking chest wound D. take a series of deep breaths

B. breathe rapidly and shallowly

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

B. collapsed jugular veins

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

B. collapsed jugular veins

Signs and symptoms of a chest injury include all of the following, except: A. hemoptysis B. hematemesis C. asymmetric chest movement D. increased pain with breathing

B. hematemesis

If a patient with a chest injury only inhales small amounts of air per breath, he or she: A. will maintain adequate minute volume if his or her respiratory rate stays the same B. must increase his or her respiratory rate to maintain adequate minute volume C. will eliminate more carbon dioxide than if he or she were breathing deeply D. often breathes at a slower rate because of lung damage caused by the injury

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

Irritation or damage to the pleural surfaces that causes sharp chest plain during inhalation is called: A. pneumonitis B. pleurisy C. dyspnea D. pneumothorax

B. pleurisy

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

B. requires prompt ventilation and oxyegnation

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

C. an open chest wound through which air moves during breathing

Signs of a cardiac tamponade include all of the following, EXCEPT: A. muffled heart tones. B. a weak, rapid pulse. C. collapsed jugular veins. D. narrowing pulse pressure.

C. collapsed jugular veins.

A 14-year-old baseball player was hit in the chest with a line drive. He is in cardiac arrest. Which of the following is the most likely explanation? A. myocadiac contusion B. traumatic asphyxia C. commotio cordis D. hemothorax

C. commotio cordis

A simple pneumothorax: A. often has a nontraumatic cause B. is caused by penetrating chest trauma C. is commonly caused by blunt chest trauma D. heals on its own without any treatment

C. is commonly caused by blunt chest trauma

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

C. signs and symptoms of shock

cardiac tamponade (pericardial tamponade)

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

The phrenic nerves control the diaphragm and exit the spinal cord at: A. C1, C2, and C3 B. C1 and C2 C. C3 and C4 D. C3, C4, and C5

D. C3, C4, and C5

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

D. coughing up blood

Which of the following organs or structures does NOT reside within the mediastinum? A. trachea B. esophagus C. vena cavae D. lung

D. lungs

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. contracts and flattens inferiorly D. might rise as high as the nipple line

D. might rise as high as the nipple line

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged: A. excess carbon dioxide will be eliminated B. minute volume will remain unchanged C. minute volume will increase D. minute volume will decrease

D. minute volume will decrease

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

D. myocardia contusion

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

D. the intercostal muscles contract

DELETE

DELETE

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

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

Myocardial contusion

hemothorax

a collection of blood in the pleural cavity

A paradoxical chest movement is typically seen in patients with

a flail chest

A flail chest occurs when:

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

a flail chest occurs when

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

Pneumothorax is defined as:

accumulation of air in the pleural space

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.

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

Subcutaneous emphysema is an indication that:

air is escaping into the chest wall from a damaged lung

hemopheumothorax

an accumulation of blood and air in the pleural space of the chest.

An open pneumothorax is

an open chest wound through which air moves during breathing

Patients with rib fractures will commonly:

breathe rapidly and shallowly.

myocardial contusion

bruising of the heart muscle

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

collapsed jugular veins.

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

Hemoptysis is defined as:

coughing up blood

During your assessment of a patient who was stabbed, you see an open wound to the left anterior chest. Your MOST immediate action should be

cover the wound with an occlusive dressing

A patient experienced a severe compression to the chest when trapped between a vehicle and a brick wall. You suspect traumatic asphyxia due to the hemorrhage into the sclera of his eyes and which other sign?

cyanosis in the face and neck

The thoracic cavity is separated from the abdominal cavity by the

diaphragm

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

diaphragm

A spontaneous pneumothorax would MOST likely occur as the result of:

exertion of a person with a congenital lung defect.

A 40-year-old man, who was the unrestrained driver of a car hit a tree at a high rate of speed, struck the steering wheel with his chest. He has a large bruise over the sternum and an irregular pulse rate of 120 beats/min. You should be most concerned that he

has injured his myocardium

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

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:

immediately request ALS support

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.

What purpose does a one-way "flutter valve" serve when used on a patient with an open pneumothorax?

it allows the release of air trapped in 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 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:

laceration of the aorta.

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

lungs

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

may rise as high as the nipple line.

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

might 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

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

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.

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:

pleurisy

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:

pneumothorax

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:

prepare for immediate transport.

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:

provide some form of positive-pressure ventilation

A patient who presents with profound cyanosis following a chest injury

requires prompt ventilation and oxygenation

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

requires prompt ventilation and oxygenation.

When assessing a patient with a hemothorax, you will MOST likely find

signs and symptoms of shock

When assessing a patient with a hemothorax, you will MOST likely find:

signs and symptoms of shock

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.

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

Very young children tend to breathe predominantly with their diaphragm because:

their intercostal muscles are not fully developed.

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

traumatic aortic rupture

When caring for a patient with signs of a pneumothorax, your most immediate concern should be

ventilatory inadequacy

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

Pleural fluid is contained between the:

visceral and parietal pleurae.