Chapter 34: Chest Trauma

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? A) Uneven chest wall movement during breathing B) Intense pain with deep inspiration C) Decreasing SpO2 reading despite high-flow oxygen D) Shortness of breath upon exertion

A

QUESTION: 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? A) "Two or more adjacent ribs are broken in two or more places." B) "Fractured ribs have collapsed the underlying lung." C) "Multiple rib fractures have bruised the underlying lung." D) "Multiple fractures to the rib cage are caused by blunt trauma."

A

QUESTION: 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: A) Starts positive pressure ventilation B) Places an ice pack over the site of injury C) Positions the patient in semi-Fowler's position for transport D) Administers oxygen through a nonrebreather face mask

A

QUESTION: 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: A) Look for a bullet exit wound posteriorly B) Get a full set of vital signs and pulse oximeter reading C) Place a cervical collar and initiate spine motion restriction precautions D) Check the blood pressure and determine whether a narrow pulse pressure exists

A

QUESTION: A patient has sustained an injury to his mediastinum. Based on the anatomy of his chest, which structure has been injured? A) Esophagus B) Bronchiole C) Diaphragm D) Lungs

A

QUESTION: 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? A) "She is getting more difficult to ventilate." B) "I do not think her jugular veins are distended." C) "Her SpO 2 has gone from 90% to 93%." D) "I see an entry wound but cannot find the exit wound anywhere."

A

QUESTION: During the secondary assessment, the EMT notes instability and a flail segment to a patient's lower left lateral chest. The EMT would immediately: A) Stabilize the segment with his hand B) Start positive pressure ventilation C) Apply bulky dressings to the area D) Auscultate breath sounds

A

QUESTION: The EMT's primary concern with any open injury to the chest is: A) Stopping air entry B) Controlling internal bleeding C) Evaluating for crepitus D) Checking for intercostal muscle damage

A

QUESTION: 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? A) Ability to speak only a few words, following by a gasp B) Respiratory rate of 20 breaths/min C) Elevated heart rate and blood pressure D) Extensive bruising to the anterior chest

A

QUESTION: Which statement made by an EMT demonstrates an understanding of chest trauma? A) "Closed chest injuries are caused by blunt trauma, and can be just as serious as open chest injuries." B) "Open chest injuries are more serious than closed chest injuries, because air and bacteria can enter the chest through the open wound." C) "Closed chest injuries are caused by penetrating trauma and cause more life -threatening injuries than do open chest injuries." D) "In general, an open chest injury caused by blunt trauma is more life threatening than a closed one due to increased potential for blood loss."

A

QUESTION: You are managing a patient with a large flail segment to the right lateral chest. With this condition, you should recognize that the immediate threat to life is: A) Hypoxia B) Infection C) Blood loss D) Rib fractures

A

QUESTION: 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 exhales. What would your immediate and best action be? A) Cover the chest wound with a gloved hand B) Obtain a sterile dressing and cover the chest wound C) Place direct pressure over the abdominal gunshot wound D) Place the patient on high-concentration oxygen with a nonrebreather face mask

A

QUESTION: 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: A) Evisceration B) Open chest injury C) Flail chest D) Laceration

B

QUESTION: 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? A) Pain B) Hypoxia C) Shock D) Pneumothorax

B

QUESTION: A paramedic has asked that you apply a dressing over a sucking chest wound. Which option is the best choice to cover this injury? A) Sterile gauze soaked in sterile water B) Petroleum gauze C) Clean washcloth D) Dry sterile gauze dressing

B

QUESTION: 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? A) Respiratory distress, absent breath sounds on the left, flat neck veins, tachycardia B) Absent breath sounds on the right, distended neck veins, tracheal deviation to the left C) Absent breath sounds on the right, tracheal deviation to the right, cyanosis D) Absent breath sounds on the left, hypotension, SpO2 of 98%, bradycardia

B

QUESTION: 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: A) Palpate the chest wall for instability B) Start positive pressure ventilation C) Examine the patient for additional injuries D) Place a cervical collar

B

QUESTION: An unrestrained female driver hit a utility pole with her vehicle at a moderate rate of speed. During the impact, she struck the steering wheel with her chest. The patient's airway is open, and she states that it is painful to breathe. Her pulse is moderate in strength, irregular, and tachycardic. Breath sounds are equal bilaterally, and no jugular venous distention is 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 the assessment findings, the EMT should be suspicious of which condition? A) Tension pneumothorax B) Cardiac contusion C) Pneumothorax D) Traumatic asphyxia

B

QUESTION: 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? A) Wound to the chest making a sucking sound B) Bluish discoloration to the neck and face C) Bilateral femur deformity D) Abdominal bruising and distention

B

QUESTION: 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: A) Cover the wound with another dressing B) Lift the dressing from the wound briefly during exhalation C) Tape the dressing on the fourth side D) Provide positive pressure ventilation with high-concentration oxygen

B

QUESTION: You have been called to a New Year's Eve 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, which finding would you consider to be the most serious and warranting immediate attention? A) Complaint of a worsening headache B) Decreased breath sounds to the left lung C) Capillary refill of 3 seconds D) Pain and bruising to the left thigh

B

QUESTION: 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? A) Take manual spine motion restriction precautions B) Insert a nasopharyngeal airway C) Evaluate the patient's SpO2 level D) Open the airway using the jaw-thrust maneuver

C

QUESTION: 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 SpO 2, 96% on supplemental oxygen. JVD is present. Given this presentation, you would have a high index of suspicion for: A) Fail segment B) Pneumothorax C) Pericardial tamponade D) Hemothorax

C

QUESTION: 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: A) Administering supplemental oxygen through a nonrebreather face mask B) Inserting an oropharyngeal airway and ventilating the patient on room air C) Providing positive pressure ventilation with oxygen attached D) Applying ice packs to the flail segment

C

QUESTION: 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? A) Apply bulky dressings to the area of chest injury B) Start positive pressure ventilation with supplemental oxygen C) Reassess for paradoxical motion of the chest wall D) Place a nonporous dressing and ice packs to the injured area

C

QUESTION: Asherman, Halo, and Bolin devices are commercially available devices to use for which injury? A) Commotio cordis B) Pneumothorax C) Open chest wound D) Flail chest

C

QUESTION: 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: A) Sucking sound at the wound site B) Infection at the wound site C) Tension pneumothorax D) Arterial bleeding

C

QUESTION: 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? A) Rib fractures B) Hemothorax C) Pulmonary contusion D) Pneumothorax

C

QUESTION: Damage to which thoracic tissues can cause impairment of ventilation from a developing pneumothorax? A) Trachea B) Pulmonary arteries C) Pleural membranes D) Mediastinum

C

QUESTION: On follow-up, the ED physician informs you that a patient whom you transported earlier was found to have a hemothorax. In this condition: A) The pleural membranes are punctured by a rib B) Fluid and blood collect around the heart C) Blood collects in the chest cavity, collapsing the lung D) The trachea is torn

C

QUESTION: 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? A) "Before we do anything, we need to put a cervical collar on the patient." B) "Use the AED but no CPR so we do not worsen the potential chest injury." C) "Let's apply the AED and follow all prompts." D) "Someone start positive pressure ventilation while I check for a blood pressure."

C

QUESTION: The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes which statement? A) "A tension pneumothorax causes blood to accumulate around the lung; a pneumothorax involves the accumulation of only air around the lung." B) "A pneumothorax describes a collapsed lung; a tension pneumothorax involves both a collapsed lung and blood loss." C) "A tension pneumothorax causes cardiac output to decrease; a simple pneumothorax does not affect cardiac output." D) "A pneumothorax is caused by a closed chest injury; a tension pneumothorax is caused by an open chest injury."

C

QUESTION: Which mechanism of injury produces the conditions for traumatic asphyxia? A) Person strangled but not killed in an attempted rape B) Penetrating chest trauma with a high-powered firearm C) Person pinned between a truck and wall of a building D) Fall of 20 feet from scaffolding onto a concrete sidewalk

C

QUESTION: 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: A) Permits oxygen to still enter the lungs B) Causes less pain for the patient C) Allows trapped air to escape on exhalation D) Decreases the chance of air entering the chest on exhalation

C

QUESTION: You suspect a trauma patient has a hemothorax to the left lung. Which assessment finding would reinforce this suspicion? A) Bradycardia and hypertension B) Neck vein distention and absent breath sounds to the right lung C) Respiratory distress and the signs and symptoms of shock D) Cyanosis and a blood pressure of 210/100 mmHg

C

QUESTION: 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? A) Provide positive pressure ventilation B) Remove the knife and seal the injury with an occlusive dressing C) Stabilize the knife with bulky dressings D) Suction the blood from the airway

D

QUESTION: 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: A) Attempt to relieve the tension while awaiting ALS arrival at the scene B) Await the arrival of ALS to "burp" the dressing between ventilations C) Initiate positive pressure ventilation utilizing FROPVD D) Call for an ALS intercept en route to the ED and lift the dressing to see if air escapes during exhalation

D

QUESTION: 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: A) Controlling pain B) Providing emotional support C) Preventing potential wound infection D) Maintaining oxygenation

D

QUESTION: An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs when: A) Air enters the lung and alveoli from a traumatic opening in the chest wall B) The lung becomes overinflated with air the patient is unable to breathe C) The trachea becomes obstructed, causing the lungs to collapse D) Air accumulates around the lung, causing a portion of it to collapse

D

QUESTION: 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 fifth rib laterally in this area. Throughout care, which action is essential to perform? A) Apply ice to area B) Splint site with a bulky dressing C) Administer aspirin for pain D) Monitor breath sou

D

QUESTION: When assessing a patient, which sign or symptom is most indicative of a pneumothorax? A) Intense pain with each inspiration B) SpO2 of less than 90% on supplemental oxygen C) Crepitus and instability to the chest wall D) Decreased breath sounds to the right lung

D

QUESTION: 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? A) New complaint of leg pain B) Increased tenderness over sternum C) Development of bruise over sternum D) Onset of an irregular heartbeat

D

QUESTION: You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. Which action is critical given this situation? A) Gently apply pressure to the chest during inhalation B) Remove the occlusive dressing C) Ensure that all four sides of the dressing are taped D) Lift one side of the dressing during exhalation

D