EMT BradyLab Chapter 27
A fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment is called a:
flail chest.
A movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity is called:
paradoxal motion
Which of the following is an accurate description of a flail chest?
section of the chest wall that is unstable, leading to breathing problems
A weak or absent radial pulse; pale, moist, cool skin; and an increased heart rate in a patient with an abdominal injury are signs of:
shock
Blunt abdominal trauma that causes the perforation of a vascular structure in the abdomen may cause:
significant blood loss.
A drawback to using sterile aluminum foil as an occlusive dressing is:
skin lacerations may occur from the sharp edges
Injury to which of the following organs would be MOST likely to cause peritonitis?
small intestine
Blunt trauma resulting in a closed chest injury creates the potential for which of the following injuries?
Contusion
Which of the following is LEAST likely to indicate abdominal injuries?
Contusions to the shoulders.
Why is it so important to seal holes in the chest from penetrating trauma as early as possible?
The lungs will collapse if air gets between the two pleural membranes.
You're an off-duty EMT who encounters a patient sitting behind the wheel of a vehicle that ran off the road along an isolated county road. It appears the patient was unrestrained, or not wearing a seat belt, and struck the steering wheel with his chest. On assessment, you notice a paradoxical motion to the patient's chest on inspiration and expiration. When you radio for dispatch of an ambulance, which of the following pieces of information would you be sure to include?
The patient may have a flail chest.
What is the purpose of a three-sided occlusive dressing?
To allow air to escape but not enter
You are stabilizing a patient who has just been stabbed in the chest to the right of the mediastinum. After placing the patient on supplemental oxygen, his shortness of breath resolves. You also cover the wound with an occlusive dressing. The patient is asymptomatic at the time you're making the decision to transport. Which of the following BEST encapsulates the correct strategy for transport?
Transport the patient emergently because of the high index of suspicion for a serious injury.
For a patient who has gunshot wounds in the lower ribs and at the same level in the back, which of the following statements is TRUE?
You need to treat the patient for both chest and abdominal wounds.
Which of the following statements is TRUE about a compression injury?
a mechanism of injury involving a compression injury is a driver striking his chest on a steering column
Which of the following is the LEAST reliable sign for determining the presence of a tension pneumothorax?
trachea that shifts to the side opposite the injury
Your patient was working on a car when it fell off the jack and trapped him between the tire and ground. His face is very blue and his eyes are bloodshot. Which of the following has the patient most likely suffered?
traumatic asphyxia
You are treating a 42-year-old male assault victim who presents with nausea, vomiting, and sharp abdominal pain. While inspecting his abdomen, you note redness to his right upper quadrant. Based on your assessment findings, the patient is MOST likely suffering from which of the following?
traumatic hemorrhage of the liver
The chest cavity can hold up to ________ liter(s) of blood in an adult, leading to the possibility of massive internal hemorrhage without any external blood loss.
3
You are caring for a 27-year-old male who has a puncture wound to the right upper chest. The patient was stabbed with a serrated steak knife by his ex-girlfriend. You have begun direct pressure to the site but lack an occlusive dressing to place over the wound. What is your LEAST acceptable option for dressing the wound?
Aluminum foil
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.
A patient with an abdominal injury will likely want to keep the legs in what position to reduce pain?
Bent
Which of the following statements is TRUE?
Bullet wounds are a type of penetrating trauma and involve both internal and external injuries.
You suspect that your patient has a tension pneumothorax. During patient assessment, which of the following findings would MOST lead to this suspicion?
Diminished or absent lung sounds on side affected by trauma; jugular venous distention; signs of shock
On assessment of the midsection of a 32-year-old male who was struck by a car, you find an abdominal evisceration with several loops of his large intestine exposed. The abdomen appears to have a clean-cut laceration and the bleeding is controlled. Which of the following is the BEST approach toward managing the exposed intestines?
Moisten a sterile dressing with saline solution and cover the abdominal contents.
Which of the following BEST describes an evisceration?
Open wound of the abdomen from which organs protrude
While assessing the abdomen of a 25-year-old female, you note that she has a large piece of glass sticking out of her right upper quadrant. What should you do?
Stabilize the glass.
An open chest wound that pulls air into the thoracic cavity is known as what type of injury?
Sucking
What is the correct terminology for a wound in which a vacuum has been created within the chest, drawing air into the thorax with each breath?
Sucking chest wound
Which of the following is MOST clearly an example of an open chest injury?
Sucking chest wound
Which of the following describes the proper application of an occlusive dressing for an open chest wound?
Tape the dressing securely on three sides.
A pneumothorax may occur when:
air leaks into the chest cavity from a damaged lung, with no opening through the outer chest.
An open abdominal wound with protruding organs is called:
an evisceration.
Severe abdominal trauma and blood loss may cause signs and symptoms of shock, which include:
an increased heart rate.
Some local protocols recommend that an abdominal evisceration should be covered with a sterile dressing moistened with sterile saline, followed by:
an occlusive dressing.
While palpating the radial pulses of a patient who was involved in a motor vehicle crash, you notice a difference in the strength of the pulses bilaterally. This is a finding that you suspect may be associated with:
aortic dissection
Which of the following traumatic chest injuries causes massive, often fatal internal hemorrhage?
aortic injury
You are dispatched to a 42-year-old male who was shot in the abdomen and thrown from a vehicle. The patient is critical and a high-category trauma; however, due to the mechanism of injury, it is necessary to backboard the patient prior to transport. What is an important assessment before securing the patient?
assessing the patient for an exit as well as an entrance wound
For both open and closed abdominal injuries, you should:
be alert for vomiting and keep the airway open
Cardiac tamponade occurs when:
blood enters the pericardial sac surrounding the heart
What type of injury is likely to produce a flail segment?
blunt trauma
Jugular venous distention is MOST likely with:
cardiac tamponade
The pathophysiology of ________ is one in which the pericardial sac fills with blood to the point where the chambers of the heart no longer fill adequately, usually secondary to trauma.
cardiac tamponade
You are on an EMS standby for a boxing tournament. During one of the matches, one of the female boxers delivers a forcible uppercut to the chest of her opponent, who falls to the ground. The match is declared over on the basis of a TKO. However, the opponent fails to arise following a one- to two-minute interval. EMS is summoned to the ring. You find the patient pulseless and breathing agonal gasps. You suspect which of the following traumatic conditions?
commotio cordis
The mechanism of injury in which a patient's chest has struck an immovable object, such as a steering wheel, may most accurately be described as a(n):
compression injury
You have covered an open chest wound with your gloved hand and the patient's breathing has improved. In order to free your hand to provide further care, you should:
cover the wound with an occlusive dressing.
What is the underlying cause of bluish, purplish, or reddish facial discoloration following a traumatic asphyxiation?
high pressure on the chest leads to blood being forced from the right atrium into the face and neck
An injury to the hollow organs in the abdomen typically leads to:
inflammation and infection
Common signs and symptoms following an injury to a hollow abdominal organ include:
irritation and peritonitis
Which of the following BEST describes the benefit of a three-sided occlusive dressing over a four-sided occlusive dressing for an open chest wound?
it reduces the chances of developing a tension pneumothorax
Which of the following BEST describes an open chest wall injury?
knife wound to the left anterior chest
When caring for a patient with an impaled object in the abdomen, the EMT should:
leave the impaled object in place and stabilize it with bulky dressings
What organ in the abdomen is MOST commonly injured by blunt trauma and can bleed profusely enough to threaten the patient's life?
liver
Which of the following is a vascular organ in the abdomen that can produce blood loss quickly enough to result in life-threatening hemorrhage following the mechanism of injury of blunt trauma?
liver
You arrive on scene to a 34-year-old male gunshot victim lying in his living room disoriented, pale, cool, and diaphoretic with shallow respirations. You note blood on his shirt at the chest and abdomen, and the puncture wound appears to be through the chest. What is your FIRST priority in treating this patient?
locate the gunshot wound on the chest and place your gloved hand over the injury
In the case of a large evisceration, you should:
place layers of bulky dressing over a dressing moistened with saline
You find a middle-aged male is sitting against a wall in obvious distress. The patient appears to be extremely short of breath and has an open wound to his chest that is making a sucking sound. You should IMMEDIATELY:
place your gloved hand over the wound.
When air is present in the chest cavity, the injury is called a:
pneumothorax
An object that is impaled in the abdomen should be:
stabilized in place.
Which of the following is the BEST strategy to maintain the covering of an occlusive dressing placed over an evisceration?
tape or cavats tied above and below the position of the exposed organ
A patient with jugular vein distention (JVD) is MOST likely suffering from which of the following injuries?
tension pneumothorax
A type of pneumothorax in which air that enters the chest cavity is prevented from escaping is:
tension pneumothorax
You respond to the scene of a 24-year-old gunshot victim and find your patient to have a decreased mental status as well as hypotension. You note absent breath sounds on the left side of his chest where you notice a puncture wound. What is this patient MOST likely suffering from?
tension pneumothorax
Which of the following statements regarding the skin's status in the case of a closed chest injury is TRUE?
the skin is not penetrated
