EMT Chapter 34
The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes which statement?
"A tension pneumothorax causes cardiac output to decrease; a simple pneumothorax does not affect cardiac output."
The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes what statement?
"A tension pneumothorax causes cardiac output to decrease; a simple pneumothorax does not affect cardiac output."
Which statement made by an EMT demonstrates an understanding of chest trauma?
"Closed chest injuries are caused by blunt trauma, and can be just as serious as open chest injuries."
An adult female is found unresponsive after being shot in the chest. Which statement made by your partner is of most concern and indicative of patient deterioration?
"She is getting more difficult to ventilate"
A new EMT who just started working with your EMS system asks you to quickly describe a flail segment. Which statement best describes this injury?
"Two or more adjacent ribs are broken in two or more places."
A construction foreman was stabbed with a screwdriver in the right anterior chest by an angry employee. Prior to your arrival, he removed the screwdriver. He is alert and oriented and complaining of pain to the injury site. Your primary assessment reveals an open airway, adequate breathing, and strong radial pulse. Based on these findings, which of the following would be done first?
. Evaluate the patient SpO2 level.
During the administration of oxygen, what is the target pulse oximeter reading that the EMT should maintain?
>94%
Which patient MOST likely has an open chest wall injury?
A patient with a knife wound to the left anterior chest
Chest injuries can result in a pneumothorax. Which statement is CORRECT about a pneumothorax?
A type of open chest wound known as a sucking chest wound can pull air into the thoracic cavity.
When assessing a patient who sustained blunt trauma to the chest, what assessment finding is most indicative of an injury to the lung?
Ability to speak a few words and then gasp
When assessing a patient who sustained blunt trauma to the chest, which assessment finding is most indicative of an injury to the lung, impairing adequate ventilations?
Ability to speak only a few words, following by a gasp
A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary assessment, which signs and/or symptoms would suggest that she is developing a tension pneumothorax?
Absent breath sounds on the right, distended neck veins, tracheal deviation to the left
A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary assessment, which of the following signs and/or symptoms would concern you that she is suffering from a tension pneumothorax?
Absent breath sounds on the right, distended neck veins, tracheal deviation to the left
An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs when:
Air accumulates around the lung, causing a portion of it to collapse
You have applied a nonporous dressing to a stab wound on a patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides and not all four. Your best response is that taping the dressing on three sides:
Allows trapped air to escape on exhalation
You are treating a patient who was stabbed in the right side of the anterior chest wall. He has shortness of breath, weakness, and rapid breathing. Aside from administering oxygen, what is the MOST appropriate treatment for this patient?
Apply an occlusive dressing on the chest wall, and tape the dressing on three sides.
On follow-up, the ED physician informs you that a patient whom you transported earlier was found to have a hemothorax. In this condition:
Blood collects in the chest cavity, collapsing the lung
On scene, a paramedic directs you to help another EMS crew who is caring for a patient who was hit and trapped under a passenger van that ran into a crowd. As you approach the patient, which scene size-up clue seemingly indicates that the patient is suffering from traumatic asphyxia?
Bluish discoloration to the neck and face
On scene, a paramedic directs you to help another EMS crew with a patient who was hit by a passenger van that ran into a crowd. As you approach the patient, what scene size-up clue seemingly indicates that the patient is suffering from traumatic asphyxia?
Bluish discoloration to the neck and face
Closed injuries to the chest are the result of what type of mechanism of injury applied to the chest wall?
Blunt
A middle-aged male patient has been stabbed once in the right anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear on the left and severely diminished on the right. JVD and tracheal deviation are present. His SpO2 is 93% on supplemental oxygen via BVM. The vital signs are pulse, 140 beats/min; respirations, 28 breaths/min; and blood pressure, 100/78 mmHg. Your next action should be to:
Call for an ALS intercept en route to the ED and lift the dressing to see if air escapes during exhalation
An unrestrained female driver hit a utility pole at a moderate rate of speed and struck the steering wheel with her chest. Her airway is open, and she states that it is painful to breathe. Her pulse is moderate in strength and irregular. Breath sounds are equal bilaterally, and there is no jugular venous distention noted. Assessment of her chest reveals bruising and instability to the sternum. When asked, she denies any past medical history. Based on this mechanism and assessment findings, the EMT should be suspicious for what condition?
Cardiac contusion
Which statement is TRUE about chest injuries?
Cavitation from a bullet is much greater than the size of the bullet itself.
A 14-year-old male was struck in the chest by a baseball. On your arrival, he is in cardiac arrest. What is the most likely explanation for the sudden cardiac arrest?
Commotio cordis
You have been called to a New Year's party for a male patient who was stabbed in the anterior chest. According to partygoers, the patient went outside with another male and was stabbed. Fifteen minutes later, he was found in the snow and 911 was called. When assessing this patient, what finding would you consider most serious and warrant immediate attention?
Decreased breath sounds to the left lung
When assessing a patient, which sign or symptom is most indicative of a pneumothorax?
Decreased breath sounds to the right lung
A patient has sustained an injury to his mediastinum. Based on the anatomy of his chest, which structure has been injured?
Esophagus
A patient has sustained an injury to his mediastinum. Based on the anatomy of his chest, which one of the following structures has been injured?
Esophagus
A construction foreman was stabbed with a screwdriver in the right anterior chest by an angry employee. Prior to your arrival, he removed the screwdriver. He is alert and oriented and complains of pain to the injury site. Your primary assessment reveals an open airway, adequate breathing, and strong radial pulse. Based on these findings, which intervention should be performed next?
Evaluate the patient's SpO2 level
Reduced tidal volume due to shifting of expiratory air from the uninjured side to the injured side is a common result of which injury?
Flail segment
Other than the lungs, what major structure is found within the thoracic cavity?
Heart
A confused 62-year-old female fell at home, hitting the side of a table with her chest. Assessment reveals instability to the left lateral chest, accompanied by minor bruising in the same area. The patient complains of intense pain every time she breathes. Her airway is patent, breathing is rapid and shallow, and skin warm and non-diaphoretic. Vital signs are pulse, 112 beats/min; respirations, 24 breaths/min; blood pressure, 132/64 mmHg; and SpO2, 90%. Breath sounds are somewhat shallow but still equal to both lungs. Based on those findings, you should treat this patient for which life-threatening condition?
Hypoxia
A confused 62-year-old female fell at home, hitting the side of a table with her chest. Assessment reveals instability to the left lateral chest accompanied by minor bruising in the same area. She complains of intense pain every time she breathes. Her airway is patent, breathing is rapid and shallow, and skin warm and nondiaphoretic. Vital signs are pulse 112, respirations 24, and blood pressure 132/64 mmHg with SpO2 at 90%. Breath sounds are shallow but equal to both lungs. Based on those findings, you should treat this patient for what life-threatening condition?
Hypoxia
You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. Which action is critical given this situation?
Lift one side of the dressing during exhalation
You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. What action is critical given this situation?
Lift one side of the dressing during expiration.
You are transporting a 19-year-old male with a gunshot wound to the chest. On scene, you covered the wound with an appropriate dressing. Now, as you reassess the patient, you note that the patient is tachypneic and complains of increased difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be to:
Lift the dressing from the wound briefly during exhalation
A patient has been shot in the chest with a rifle. Assessment reveals a deteriorating level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and the entrance wound, which is located midclavicular at the second intercostal space on the left side of the chest, has been covered with an occlusive dressing. Your next priority action would be to:
Look for a bullet exit wound posteriorly
A young boy has an open chest wound to the left lateral thorax after falling off his bike onto a metal spike protruding from the ground. His family is present; they are very upset and crying. As an EMT, you recognize that in this situation, your primary focus is:
Maintaining oxygenation
An alert and oriented young male fell 5 feet from a stage, impacting a metal railing with the right side of his chest, just under his armpit. The primary assessment is negative for life threats, although he does complain of very painful breathing and has remarkable tenderness and crepitus over the 5th rib laterally in this area. Throughout care, what action is essential to perform?
Monitor breath sounds.
You are transporting a young and healthy female patient who was involved in a motor vehicle collision and struck her chest on the steering column. Although the primary assessment reveals no life threats, she does have redness to her sternum, as well as pain and tenderness. Breath sounds are clear and present bilaterally and vital signs are within normal limits. As you transport and reassess her, what sign or symptom would be most concerning?
Onset of an irregular heartbeat
You are transporting a young and healthy female patient who was involved in a motor vehicle collision, during which she struck her chest on the steering column. Although the primary assessment reveals no life threats, the patient does have redness to her sternum, as well as pain and tenderness. Breath sounds are clear and present bilaterally, and vital signs are within normal limits. As you transport and reassess this patient, which sign or symptom would indicate the immediate need for ALS?
Onset of irregular heartbeat
A 39-year-old male has a single stab wound to the anterior chest. When notifying the emergency department, you inform them that the patient has a/an:
Open chest wound
Asherman, Halo, and Bolin devices are commercially available devices to use for which injury?
Open chest wound
Your patient was shot in the right upper chest. Upon inspecting the wound, you notice that is bubbles each time the patient exhales. Which injury is MOST likely?
Open pneumothorax
A 23-year-old female has been involved in a serious motor vehicle collision. Which assessment finding best indicates that she has a flail segment?
Paradoxical chest wall movement
A middle-aged male has been stabbed once in the left anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear and equal bilaterally. The vital signs are pulse, 140 breaths/min; respirations, 24 breaths/min; blood pressure, 100/78 mmHg; and SpO2, 96% on supplemental oxygen. JVD is present. Given this presentation, you would have a high index of suspicion for:
Pericardial tamponade
Which injury is virtually always the result of penetrating chest trauma?
Pericardial tamponade
Your patient was stabbed in the left anterior chest wall at the midclavicular line and fourth rib. His breath sounds are normal, but he is in severe distress and obvious shock. What do you suspect has happened to him?
Pericardial tamponade
What mechanism of injury produces the conditions for traumatic asphyxia?
Person pinned between a truck and wall of a building
Which mechanism of injury produces the conditions for traumatic asphyxia?
Person pinned between a truck and wall of a building
A paramedic has asked that you apply a dressing over a sucking chest wound. Which option is the best choice to cover this injury?
Petroleum gauze
Damage to tissues of what thoracic structure(s) will cause impairment of ventilation and a pneumothorax?
Pleural membranes
Damage to which thoracic tissues can cause impairment of ventilation from a developing pneumothorax?
Pleural membranes
A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused, her breathing is rapid and shallow, and breath sounds are diminished bilaterally. After manually stabilizing the flail section of the chest wall, the EMT best treats this condition by:
Providing positive pressure ventilation with oxygen attached
Assessment findings for a patient who was thrown from a motorcycle indicate that he has a flail chest wall segment to his right anterior chest. He exhibits labored breathing and an SpO2 of 92%. Breath sounds are clear and equal bilaterally. The segment has been stabilized, and you are prepared to start positive pressure ventilation. Given these assessment findings, which type of injury underlying the flail segment is your primary concern?
Pulmonary contusion
Assessment findings of a patient ejected from a motorcycle indicate that he has a flail chest wall segment to his right anterior chest. He exhibits labored breathing and an SpO2 at 94%. Breath sounds are clear and equal bilaterally. The segment has been stabilized, and you are prepared to start positive pressure ventilation. Given these assessment findings, what type of injury underlying the flail segment is your primary concern?
Pulmonary contusion
Which term is used for bleeding that occurs in and around the alveoli, reducing oxygen exchange?
Pulmonary contusion
A young male patient has self-extricated from his vehicle after hitting a telephone pole and rolling his car several times at a high rate of speed. He is spitting blood and has a large area of tenderness and soft tissue injury to the left side of his chest. On scene, you did not observe any paradoxical motion of the chest wall. The patient remains alert and oriented with stable vital signs, but continually complains of painful breathing. During transport, what is it essential that you do?
Reassess for paradoxical motion of the chest wall
A young male patient is self-extricated after hitting a telephone pole and rolling his car several times at a high rate of speed. He is spitting blood and has a large area of tenderness and instability to the left side of his chest. On scene you did not observe any paradoxical motion of the chest wall. The patient remains alert and oriented with stable vital signs, but continually complains of painful breathing. During transport, what is it essential that you do?
Reassess for paradoxical motion of the chest wall.
You suspect a trauma patient has a hemothorax to the left lung. Which assessment finding would reinforce this suspicion?
Respiratory distress and signs and symptoms of shock
You suspect a trauma patient to be suffering from a hemothorax to the left lung. What assessment finding would reinforce this suspicion?
Respiratory distress and the signs and symptoms of shock
An unrestrained 32-year-old female motorist hit a utility pole head-on at 45 mph. The car sustained extensive damage. The patient has an open airway, is breathing poorly at 32 breaths per minute with absent alveolar breath sounds, and is responsive to painful stimuli. Her radial pulse is rapid and weak, and her skin is cool and cyanotic. Breath sounds are decreased on the right side. Emergency Medical Responders are initiating spine motion restriction precautions. Your next action would be to:
Start positive pressure ventilation
The EMT's primary concern with any open injury to the chest is:
Stopping air entry
An open chest wound that pulls air into the thoracic cavity is known as what type of injury?
Sucking
A 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and the patient now complains of shortness of breath. When he speaks, he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which intervention should you perform first?
Suction the blood from the airway
A 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and he is complaining of shortness of breath. When he speaks he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which one of the following should you do first?
Suction the blood from the airway.
Assessment findings for a 33-year-old female who was shot in the right side of the chest indicate that she has a pneumothorax. As you care for this patient, your primary concern is monitoring the injury for:
Tension pneumothorax
In which thoracic injury is a mechanical collapse of the vena cava involved?
Tension pneumothorax
Why is the right lung responsible for about 60 percent of normal oxygenation?
The right lung has three lobes.
What occurs when the diaphragm and intercostal muscles contract?
The thoracic cage enlarges, causing a decrease in intrathoracic and intrapulmonary pressures.
Which of the following best describes a flail segment?
Two or more adjacent ribs broken in two or more places
A 23-year-old female has been involved in a serious motor vehicle collision. Which assessment finding best indicates that she has a flail segment?
Uneven chest wall movement during breathing
A paramedic has asked that you apply a dressing over a sucking chest wound. What is best to cover the injury?
Vaseline gauze
Treatment for any type of chest injury complication includes:
administration of high-concentration oxygen.
An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs when:
air accumulates around the lung, causing a portion of it to collapse.
You have applied a nonporous dressing to a stab wound on a patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides and not all four. Your best response is that taping the dressing on three sides:
allows trapped air to escape on exhalation.
When you are treating a patient who sustained a rib fracture, you should administer oxygen if the patient is in respiratory distress and:
apply a sling and swathe to the patient.
If you are treating a patient who was struck in the chest with a ball and suffered sudden cardiac arrest, begin CPR and NEXT:
apply the AED.
On follow-up, the ED physician informs you that a patient you transported earlier was found to have a hemothorax. You would understand this is a condition in which:
blood collected in the chest.
Cardiac tamponade occurs when:
blood enters the pericardial sac surrounding the heart.
Pulmonary contusions are serious injuries because they:
can interfere with oxygen exchange.
Jugular vein distention is a possible indication of:
cardiac tamponade.
You are on the scene of a shooting. Your assessment reveals a 23-year-old male who has been shot twice. The first wound is to the left lower quadrant of the abdomen and is actively bleeding. The second wound is to the left lateral chest and bubbles every time the patient takes a breath. Your immediate action would be:
cover the chest wound with a gloved hand.
Two or more adjacent ribs that are broken in two or more places is called a/n:
flail segment.
When blood collects inside the pleural space after a rib fracture that lacerates an intercostal artery, the condition is called a/an:
hemothorax.
When caring for a 26-year-old female patient with an impaled object in the side of the chest, you should:
leave the impaled object in place and stabilize it with bulky dressings.
You are transporting a 19-year-old male with a gunshot wound to the chest. On scene you covered the wound with an appropriate dressing. Now, as you reassess the patient, you note that the patient is tachypneic and complaining of difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be to:
lift the dressing from the wound for several seconds.
A patient has been shot in the chest with a rifle. Assessment reveals a deteriorating level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and the entrance wound, located midclavicular at the second intercostal space on the left side of the chest, has been covered. Your next action would be to:
look for an exit wound.
A young boy has an open chest wound to the left lateral area after falling off of his bike onto a metal spike in the ground. His family is present and very upset and crying. As an EMT, you recognize that in this situation, your primary focus is:
maintaining oxygenation.
Care for an open chest wound and an abdominal evisceration are similar in that:
occlusive dressings are placed over both wounds.
A 39-year-old male has a single stab wound to the anterior chest. When notifying the emergency department, you inform them that the patient is suffering from a(n):
open chest injury.
During your physical examination of a patient who was hit in the chest with a baseball bat, you notice that a small section of his ribcage sinks when he inhales and moves outward when he exhales. This is known as:
paradoxical movement.
A middle-aged male has been stabbed once in the left anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear and equal bilaterally. The vital signs are: pulse 140, respirations 24, blood pressure 100/78 mmHg, and SpO2 96% on supplemental oxygen. Given this presentation, you would have a high index of suspicion for:
pericardial tamponade.
When blood collects inside the pericardial sac, the condition is called:
pericardial tamponade.
The nerve that transmits the inspiratory signal from the medulla to the diaphragm by way of the spinal cord is called the:
phrenic nerve.
A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused and breathing rapidly and shallowly. After manually stabilizing the flail section of the chest wall, the EMT best treats this condition by:
providing positive pressure ventilation.
During the secondary assessment, the EMT notes instability and a flail segment to a patient's lower left lateral chest. The EMT would immediately:
stabilize the segment with his hand.
An unrestrained 32-year-old female motorist hit a utility pole head on at 45 mph. The car sustained extensive damage. She has an open airway, breathing poorly at 32 breaths per minute, and is responsive to painful stimuli. The radial pulse is rapid and weak, and her skin is cool and cyanotic. Breath sounds are decreased on the right side. Emergency Medical Responders are maintaining manual in-line stabilization. Your next action would be to:
start positive pressure ventilation.
A patient has been involved in a motorcycle crash and has a flail segment to the right lateral chest. His airway is open and he is breathing poorly at 24 breaths per minute with a decreasing SpO2. The EMT shows that he is appropriately caring for this injury when he:
starts positive pressure ventilation.
The EMT's primary and first concern with any open injury to the chest is:
stopping air entry.
Assessment findings on a 33-year-old female who has been shot in the right side of the chest indicate that she is suffering from a pneumothorax. As you care for this patient, your primary concern is monitoring the injury for:
tension pneumothorax.
If a patient has an open chest wound that allowed air to accumulate into the pleural cavity to the point at which the lung is totally collapsed and is starting to shift to the other side, this additional complication is known as:
tension pneumothorax.
The danger of blood collecting inside the pericardial sac after blunt chest wall trauma is that:
the heart cannot contract as effectively.
The process of moving air into and out of the lungs is MOST accurately referred to as:
ventilation.
Which statement made by an EMT demonstrates an understanding of chest trauma?
"Closed chest injuries are caused by blunt trauma and can be just as serious as open chest injuries."
On scene at a college football game, a wide receiver is unresponsive after colliding with another player and forcefully taking a helmet to the chest. The athletic trainer reports that the patient is pulseless and apneic. Given the mechanism of injury and patient's presentation, which instruction would be appropriate?
"Let's apply the AED and follow all prompts."
An adult female is found unresponsive after being shot in the chest. Which statement made by your partner is of most concern?
"She is getting more difficult to ventilate."
