Chapter 29

A 20 year old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assesment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superifical. You should: A. carefully probe the wound to determine its depth B. assume that the arrow injured an internal organ C. clean the wound and apply a dry, sterile dressing D. transport only if signs of shock begin to develop.

B

A 66 year old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert, however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him? A. Do you take any over-the-counter medications? B. Have you experienced recent abdominal trauma? C. Has blood soaked through your undergarments? D. What does your blood pressure normally run?

B

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

B

Air in the abdominal cavity can cause all of the following EXCEPT: A. pain B. diarrhea C. infection D. tissue ischemia and infarction

B

Blunt abdominal injuries may result from: A. a stab wound B. seat belts C. a gunshot wound D. an impaled object

B

Children are often "belly breathers" because _______. Select one: A. they are routinely hypoxic B. their intercostal muscles are not developed C. they are consciously controlling ventilations D. their diaphragm is not functional

B

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. air bag deployment B. a poorly placed lap belt C. failure to wear seat belts D. rapid vehicle deceleration

B

Following blunt abdominal trauma, a 30 year old male complains of referred pain to the left shoulder. This finding is called the: A. Grey Turner sign B. Kehr sign C. Brudzinski sign D. Cullen sign

B

Immediately life-threatening chest injuries must be found and managed during the _______. Select one: A. scene size-up B. primary assessment C. secondary assessment D. patient history

B

Late signs of peritonitis may include: A. soft abdomen B. nausea C. normal bowel sounds D. diarrhea

B

The most common sign of significant abdominal injury is: A. pain B. tachycardia C. rigidity D. distention

B

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

B

Which of the following is NOT a hollow organ of the abdomen? A. Stomach B. Liver C. Bladder D. Urters

B

Which of the following is most likely to cause immediate death? Select one: A. Aortic dissection B. Aortic rupture C. Pulmonary contusion D. Myocardial contusion

B

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: Select one: A. immediately perform a rapid head-to-toe exam. B. administer oxygen and transport to the hospital. C. recognize that he needs a needle decompression. D. circumferentially tape a dressing around his chest.

B

Your presence is requested by law enforcement to assess a 33 year old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should: A. arrange for a rape crisis center representative to speak with the patient. B. control any external bleeding, administer oxygen, and transport at once. C. visualize the vaginal area and pack the vagina with sterile dressings D. allow her to change her clothes and take a shower before you transport

B

Your primary concern when dealing with an unresponsive patient with an open abdominal injury is: A. covering the wound with a moist dressing B. maintaining the airway C. controlling the bleeding D. monitoring vital signs

B

Open abdominal injuries are also known as: A. blunt injuries B. eviscerations C. penetrating injuries D. peritoneal injuries

C

The presence of tachycardia following a significant abdominal injury: A. indicates a state of decompensated shock B. should be assumed to be a sign of shock C. is most commonly caused by severe pain D. is always accompanied by hypo tension

C

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: Select one: A. pulmonary contusion. B. massive hemothorax. C. traumatic asphyxia. D. tension pneumothorax.

A

Because solid organs have a rich supply of blood, any injury can result in major: A. hemorrhaging B. damage C. pain D. guarding

A

Patients with chest injuries will often present with _______. Select one: A. tachypnea B. agonal respirations C. Kussmaul respirations D. Cheyne-Stokes respirations

A

The largest organ in the abdomen is the: A. liver B. spleen C. pancreas D. kidneys

A

The major complaint of patients with abdominal injury is: A. pain B. tachycardia C. rigidity D. swelling

A

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

A

While assessing a 21 year old female who struck a tree head-on with her small passenger car, you not that her air bag deployed. You should: A. life the air bag and look for deformity to the steering wheel. B. carefully assess her upper chest for seat belt-related injuries C. perform a head-to-toe assessment while she is in the car D. extricate her immediately and transport to a trauma center

A

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: Select one: A. laceration of the aorta. B. massive hemothorax. C. pericardial tamponade. D. tension pneumothorax.

A

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: Select one: A. immediately request ALS support. B. obtain a set of baseline vital signs. C. insert an oropharyngeal airway. D. perform a focused secondary exam.

A

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

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?

prepare for immediate transport

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:

pulmonary contusion

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:

repeats BP of 92/68 mmHg

A patient with a chest injury has a blood pressure of 100/60 mm Hg and a pulse rate of 120 beats/min. Which of the following additional findings should make you suspect a pericardial tamponade?

_____ takes place in the solid organs. A. digestion B. Excretion C. Energy production D. Absorption

C

their intercostal muscles are not developed

Children are often "belly breathers" because _______.

blunt trauma

Closed chest injuries are typically caused by _______.

hematemesis

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

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: Select one: A. determine if he has cardiac problems. B. apply bulky dressings to the sternum. C. apply an AED and assess his BP. D. prepare for immediate transport.

D

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

D

A spinal cord injury at the level of C7 would MOST likely result in: Select one: A. paralysis of the diaphragm. B. paralysis of all the respiratory muscles. C. immediate cardiac arrest. D. paralysis of the intercostal muscles.

D

All of the following systems contain organs that make up the contents of the abominal cavity EXCEPT: A. the digestive system B. the urinary system C. the genitourinary system D. the limbic system

D

An open pneumothorax occurs when: Select one: A. air enters the pleural space from a perforated lung. B. extreme pleural pressure causes the lung to rupture. C. a fractured rib perforates the tissue of the lung. D. air enters the pleural space from outside the body.

D

Closed chest injuries are typically caused by _______. Select one: A. high-velocity weapons B. penetrating trauma C. flying debris D. blunt trauma

D

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? Select one: A. Diminished breath sounds B. A rapid, irregular pulse C. Widening pulse pressure D. Engorged jugular veins

D

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

D

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: Select one: A. cardiac tamponade. B. myocardial contusion. C. flail chest. D. pneumothorax.

D

The first signs of peritonitis include all of the following EXCEPT: A. severe abdominal pain B. tenderness C. muscular spasm D. nausea

D

Which of the following statements regarding abdominal evisceration's is correct? A. Adherent material is preferred when covering an evisceration. B. The organs should be replaced carefully to avoid heat loss. C. Most evisceration's occur to the left upper quadrant D. The protruding organs should be kept warm and moist.

D

You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if: A. the severity of the injury is known. B. the patient is conscious. C. there are other patients involved. D. law enforcement is at the scene.

D

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: Select one: A. begin rapid transport at once. B. call for a paramedic ambulance. C. begin ventilatory assistance. D. partially remove the dressing.

D

Beck's triad

Distended jugular veins, narrowing pulse pressure, and muffled heart tones are collectively known as _______.

engorged jugular veins

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?

provide ventilation assistance with a BVM

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:

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:

traumatic aortic rupture

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

primary assessment

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

pneumothorax

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:

sponatenous pneumothorax

May be the result of rupture of a weak spot on the lung, allowing air to enter the pleural space and accumalate. this often results from nontraumatic injuries and may occur during times of physical activity such as excerise

flail chest

Paradoxical motion is a sign of a _______.

tachypnea

Patients with chest injuries will often present with _______.

collapsed jugular veins

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

diaphragm

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

may rise as high as the nipple line.

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

aortic rupture

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

administer oxygen and transport to the hospita

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:

compression of the aorta and vena cava

You are transporting a stable patient with a possible pneumothorax. The patient is receiving high-flow 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?

laceration of the aorta

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:

partially remove the dressing

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:

immediately request ALS support.

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:

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

a flail chest occurs when:

penetrate the lung and diaphragm and injure the liver or stomach

a penetrating chest injury has the potential to

myocardial contusion

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

is commonly caused by blunt chest trauma.

a simple pneumothorax

paralysis of the intercoastal muscles

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

high-flow oxygen or ventilation with BVM

all patients with chest injuries should recieve

air enters the pleural space from outside the body

an open pneumothorax occurs when:

pneumothorax Occusive dressing

any penetrating injury to the chest may result in air entering the pleural space and may cause what type of dressing should be used

open injuries

are the result of an object penetrating the skin and/or chest wall

open or closed

chest injuries are classifed as

lungs

hemoptysis indicates damage to the

minute volume will decrease

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

pleurisy

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

hemothorax

is the result of blood accumulating in the plueral space after a traumatic injury when the vessels of the lung are lacerated and leak blood

simple pneumothorax

is the result of blunt trauma, such as fractured ribs

pneumothorax

may progress to a tension __ and cause cardiac arrest

blunt trauma

may result in fractures to the ribs and the sternum

life-threatening hemorrage

must be addressed immediately during the primary assessment even before airway or breathing concerns

commotio cordis

occurs from direct blows to the chest during a critical portion of the patient's heartbeat. it may result in immediate cardiac arrest

closed injuries

often the result of blunt force trauma

breathe rapidly and shallowly

patients with rib fractures will commonly

accumulation of air in the pleural space

pneumothorax is defined as:

ventilation

the body's ability to move air in and out of the lungs is called

mediastinum

the esophagus, trachea, and great vessels of the body are located in the

increases the risk of internal injury

the pliability of the pediatric rib cage

inserting a needle through the rib cage into the pleural space

the treatment for relieving a tension pneumothorax involves

myocardial contusion -bruising of the heart muscle after traumatic injury

this condition may have the same signs and symptons as a heart attack, including an irregular pulse, this injuryis an injury to the heart muscle from trauma not from a heart attack

flail chest segment postive-pressure ventilation

three or more ribs broken in two or more places what ventilation may be particularly important for a patient with a flail chest that compromises ventilation

pulmonary contusion-bruising of or injury to lung tissue after traumatic injury

what may interfere with oxygen exchange in the lung tissue

open pneumothorax

when a penetrating injury creates a hole in the chest wall, you may hear a sucking sound as the patient inhales this is called

signs and symptons of shock

when assessing a patinet with a hemothorax, you will MOST likely find

cardiac tamponade

when blood collects in the space between the pericardial sac and the heart. this condition results in pressure building up inside the pericardial sac until the heart cannot pump effectively; cardiac arrest may occur quickly