Exam IV: Trauma

The kidneys are located in the: a) peritoneal space b) pelvic cavity c) visceral peritoneum d) retroperitoneal cavity

d) retroperitoneal cavity

This is an immediately life-threatening condition resulting from a pneumothorax that continues to trap air in the thoracic cavity with no relief or escape. With each breath, air accumulates in the thoracic cavity on the injured side. This completely collapses the injured lung and begins to compress and shift the mediastinum over to the uninjured side a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade

d) tension pneumothorax

Signs of compensated shock include all of the following, EXCEPT a) restlessness or anxiety b) pale, cool, clammy skin c) a feeling of impending doom d) weak or absent peripheral pulses

d) weak or absent peripheral pulses

This occurs when the thoracic cavity is filled with blood rather than air. As the blood continues to collect, the lung is compressed. a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade

e) hemothorax

This occurs when severe and sudden compression of the thorax causes a rapid increase in the pressure in the chest. The heart and lungs are usually severely compressed by the sternum and ribs, causing a backflow of blood out of the right ventricle and into the veins of the head, shoulders, and upper chest. a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade I) cardiac contusion

f) traumatic asyphxia

What are the typical vital signs for someone suffering from trauma to the chest

1) BP: normal; may be low if severe hypoxia, blood loss, tension pneumothorax, cardiac tamponade or narrow pulse pressure 2) HR: normal, or tachycardia from severe hypoxia, blood loss, tension pneumothorax, or cardiac tamponade 3) Pulses may become weak or absent during inhalation indicating a tension pneumothorax or pericardial tamponade 4) RR: normal, irregular, decreased, absent, or labored Skin: normal; may be pale, cool, clammy if severe hypoxia, blood loss, tension pneumothorax, or cardiac tamponade 5) Pupils: equal and reactive, may be sluggish to respond to light 6) SpO2: less than 95% if gas exchange is affected

What are the five types of cariogenic shock?

1) From MI (myocardial infarction) 2) From CHF (congestive heart failure) 3) From abnormal rhythm 4) From depressed pump function 5) From beta blockers/calcium channel blockers

What are the three etiologies of shock?

1) Inadequate volume 2) Inadequate pump function 3) Inadequate vessel tone

What are the four pathologies associated with sepsis?

1) Increased capillary permeability 2) Vasodilation 3) Myocardial depression 4) Alveolar/capillary membrane damage allowing fluid to accumulate in the alveoli

What are some of the potential symptoms of a tension pneumothorax?

1) Rapid deterioration 2) severe respiratory distress 3) signs of shock 4) absent breath 5) sounds on one side of the chest 6) cyanosis 7) unequal movement of the chest 8) distended neck veins 9) diminished breath sounds on the side opposite to the injury 10) deviation of the trachea to the uninjured side

What are the three types of distributive shock?

1) Septic 2) Neurogenic 3) Anaphylactic

What are three things you should assess for when examining the neck of a trauma patient?

1) Subcutaneous emphysema 2) Jugular vein distension 3) tracheal deviation

What are the key physical findings associated with sepsis?

1) Tachycardia 2) Tachypnea 3) Hyperthermia or hypothermia 4) Hypotension 5) Flushed, warm skin (early) 6) Mottled and cyanotic skin (late) 7) Altered mental status

What are six potential questions to ask when determining MOI for chest trauma?

1) Was the patient involved in a sports accident? 2) Did the patient fall? 3) Was there a fight? 4) Is there any evidence that a shooting took place? 5) Was the patient involved in an auto collision? 6) Was the patient crushed? 7) Was there an explosion?

A tension pneumothorax usually produces ___________ breath sounds on the injured side and _____________ breath sounds on the side of the uninjured lung

1) absent 2) decreased

A patient who presents in shock must be categorized as _______ and _________ and considered for expeditious transport following the primary assessment and initial emergency care

1) critical 2) unstable

During exhalation, the diaphragm would be located at approximately the level of the _____ or _______ intercostal space, which is at the ________ line

1) fourth 2) fifth 3) nipple

What are the three types of hypovolemic shock?

1) hemorrhagic 2) nonhemorrhagic 3) burn

What are the four major categories of shock? (What is the fifth)

1) hypovolemic 2) distributive 3) cardiogenic 4) obstructive 5) metabolic/ respiratory

What are the two conditions that can lead to cariogenic shock?

1) tension pneumothorax 2) pericardial tamponade

What are the three types of obstructive shock?

1) tension pneumothorax 2) pulmonic embolism 3) pericardial tamponade

What is the type fo shock that is caused by ineffective pump function of the heart?

Cardiogenic Shock

This shock occurs when dilated vessels cause a reduction in the systemic vascular resistance, resulting in a decrease in blood pressure and perfusion. The loss of fluid from the capillary further reduces the intravascular volume, causing the preload, stroke volume, cardiac output, systolic blood pressure, and perfusion to decrease, resulting in a shock state

Anaphylactic Shock

The following are the physical presentations in which phenomenon? a) the presence of jugular vein distention, muffled heart sounds, and a narrowing pulse pressure where the systolic and diastolic blood pressures start to merge.

Beck's Triad

A patient might suffer a pneumothorax in the absence of blunt or penetrating trauma to the chest. This condition is called a spontaneous pneumothorax because it occurs without an external cause. It usually is the result of a congenitally weak area on the surface of the lung. What is this weak area of the lung called?

Bleb

What is the type of shock associated with a decrease in intravascular volume caused by massive systemic vasodilation and an increase in capillary permeability?

Distributive shock

This can occur in a chest trauma and is coughing up blood or blood-stained sputum

Hemoptysis

What is the type of shock that results from the loss of whole blood from the intravascular space?

Hemorrhagic hypovolemic shock

This is the bulging of the veins in the neck which is an indication of possible cardiac injury or tension pneumothorax

Jugular vein distension (JVD)

Blood is not irritating to the peritoneal lining and might not cause severe abdominal pain, even though the patient might bleed severely. However, the blood might irritate the diaphragm and cause referred pain to the shoulder. This referred pain to the shoulder is called __________

Kehr sign

What is another word for shock?

Hypoperfusion

What is the type fo shock that is caused from low blood volume?

Hypovolemic shock

This is common cardiac injury following severe blunt trauma to the chest. It occurs as the heart is violently compressed between the sternum and the spinal column a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade I) cardiac contusion

I) cardiac contusion

What is the immediate treatment for an open pneumothorax or any penetrative trauma to the chest?

Initially seal it with your gloved hand and then with an occlusive dressing

What is the type of shock in which a spinal cord injury may damage the sympathetic nerve fibers that control vessel tone below the level of injury?

Neurogenic shock

What is the type of shock that is caused by the shift of fluid out of the intravascular space; however, red blood cells and hemoglobin remain within the vessels?

Nonhemorrhagic hypovolemic shock

This shock results from sepsis, which is an exaggerated inflammatory response to an infection that causes the vessels throughout the body to dilate and become permeable

Septic shock

Describes a state of collapse and failure of the cardiovascular system

Shock

What is the first step in managing a hemorrhagic hypovolemic shock?

Stop the bleeding

This is the condition when air is trapped under the skin giving it a bubbly, inflated appearance and a crackling feel when palpated) is usually present in the upper chest and neck

Subcutaneous emphysema

If an open wound to the chest is at least _______ the internal diameter of the trachea, a significant amount of air will be sucked into the open wound to the chest and into the pleural space, and not through the trachea and into the lungs a) 2/3 b) 1/2 c) 1/3 d) equal to

a) 2/3

A pulse pressure of less than ______ may be see in patients with shock a) 25 mmHg b) 45 mmHg c) 60 mmHg d) 30 mmHg

a) 25 mmHg

A laceration to the scrotum should have bleeding control in what form? a) Direct pressure and cold compress b) Pressure dressing c) Packing d) Hemostatic agent

a) Direct pressure and cold compress

What is jugular vein distention during inhalation an indicator of? a) Tension pneumothorax b) A flail segment c) Tracheal deviation d) Subcutaneous emphysema

a) Tension pneumothorax

A 33-year-old woman presents with a generalized rash, facial swelling, and hypotension approximately 10 minutes after being stung by a hornet. Her BP is 70/50 mm Hg and her heart rate is 120 beats/min. In addition to high-flow oxygen, this patient is in MOST immediate need of a) epinephrine b) rapid transport c) an antihistamine d) IV fluids

a) epinephrine

All of the following are potential causes of impaired tissue perfusion, EXCEPT a) increased number of red blood cells b) pump failure c) low fluid volume d) poor vessel function

a) increased number of red blood cells

This occurs when there is an open chest injury is the result of a penetrating chest wound a) open chest injury b) closed chest injury c) abrasive chest injury d) blunt chest injury

a) open chest injury

If a puncture to the visceral pleura, the parietal pleura, or both pleura occurs, the seal is broken and air is sucked into the pleural space each time the chest wall expands. As the pleural space expands, it creates pressure on the lung and the lung collapses. What is this phenomena? a) pneumothorax b) tension pneumothorax c) pleural pneumothorax d) puncture pneumothroax

a) pneumothorax

What do you call bleeding within the lung tissue and is often a serious consequence of a flail segment or other blunt force injury and can lead to death? a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade

a) pulmonary contusion

A 60-year-old woman presents with a BP of 80/60 mm Hg, a pulse rate of 110 beats/min, mottled skin, and a temperature of 103.9°F. She is MOST likely experiencing a) septic shock b) neurogenic shock c) profound heart failure d) a severe viral infection

a) septic shock

This occurs when an open chest wound can pull air into the thoracic cavity, sometimes with a noticeable sucking sound a) sucking chest wound b) high pressure chest wound c) paradoxical chest wound d) sucking pneumothorax

a) sucking chest wound

Evaluate abdominal pain history use=ing a) the OPQRST mnemonic b) the SAMPLE mnemonic c) the Markle test d) palpation

a) the OPQRST mnemonic

The chest cavity is called a) thoracic cavity b) pericardial cavity b) chest cavity d) abdominal cavity

a) thoracic cavity

Anaphylactic shock is typically associated with a) urticaria b) bradycardia c) localized welts d) a severe headache

a) urticaria

What is the a) innermost layer of the chest that is in contact with the lungs and what is the b) outermost layer that is in contact with the thoracic wall?

a) visceral pleura b) parietal pleura

How should the EMT bandage an abdominal wound in which abdominal organs are not protruding through? a) Apply a moist dressing b) Apply a dry sterile dressing c) Flush the wound and cover with an occlusive dressing d) Cover with an occlusive dressing

b) Apply a dry sterile dressing

Which shock type is an exaggerated inflammatory response to an infection that causes the vessels throughout the body to dilate and become permeable? a) Anaphylactic shock b) Septic shock c) Burn shock d) Distributive shock

b) Septic shock

What is the rectangular portion of the anterior chest framed by the clavicles superiorly, midclavicular lines laterally, and costal margin inferiorly? a) cardiac area b) cardiac box c) pericardial box d) cardiac region

b) cardiac box

The term "shock" is MOST accurately defined as a) a decreased supply of oxygen to the brain b) cardiovascular collapse leading to inadequate perfusion c) decreased circulation of blood within the venous circulation d) decreased function of the respiratory system leading to hypoxia

b) cardiovascular collapse leading to inadequate perfusion

This occurs when there is blunt trauma is applied to the chest a) open chest injury b) closed chest injury c) abrasive chest injury d) blunt chest injury

b) closed chest injury

What problems does a tension pneumothorax cause besides collapsing the lung? a) it causes a flail segment b) it compresses the heart c) it causes a hemothorax d) it causes jugular vein collapse

b) it compresses the heart

One defining sign of a flail segment is: a) an open chest wound b) paradoxical movement c) cyanosis d) shortness of breath

b) paradoxical movement

The peritoneal lining has nerves that produce severe pain when subjected to a) movement b) substances leaking into the cavity c) peristalsis d) cramping

b) substances leaking into the cavity

This occurs when there is air leaking into the chest cavity from a damaged lung with no opening through the outer chest wall cannot be managed by EMTs in the prehospital setting a) pneumothorax b) tension pneumothorax c) pleural pneumothorax d) puncture pneumothorax

b) tension pneumothorax

What should you do when caring for an abdominal evisceration? a) Dress with a dry abdominal pad b) Apply an occlusive dressing c) Cover the wound with a moist dressing and an occlusive dressing d) Place the organs back in the abdomen and cover

c) Cover the wound with a moist dressing and an occlusive dressing

If you note an open wound to the chest, what should you immediately do? a) Bandage the wound with a nonporous dressing taped on 3 sides b) Check for jugular vein distention c) Place a gloved hand over the wound d) Bandage the wound with a nonporous dressing taped on all 4 sides

c) Place a gloved hand over the wound

A nonporous dressing, taped on three sides prevents: a) a pneumothorax b) air exit on expiration c) air entry on inspiration d) a hemothorax

c) air entry on inspiration

This creates a segment of the chest that is unattached to the rest of the rib cage, an injury known as a a) fling segment b) lung segment c) flail segment d) open chest segment

c) flail segment

What occurs when two or more consecutive ribs have been fractured in two or more places, producing a freely moving section of chest wall? a) fling segment b) lung segment c) flail segment d) open chest segment

c) flail segment

Which three organs cannot tolerate low blood volume? a) skin, heart, intestines b) heart, lungs, intestines c) heart, lungs, brain d) brain, lungs, kidney

c) heart, lungs, brain

What is the hollow area in the middle of the thoracic cavity between the right and left lungs? a) middle cavity b) mediathroacic cavity c) mediastinum d) mediacron

c) mediastinum

This is the result of an open wound to the chest created by a penetrating object. Air can be heard escaping or entering through the chest wound, creating a bubbling or sucking sound. An open pneumothorax is referred to as a "sucking chest wound?" a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade

c) open pneumothorax

What is the space between the pleural layers? a) plural space b) thoracic space c) potential space d) visceral space

c) potential space

Potential causes of cardiogenic shock include all of the following, EXCEPT a) inadequate heart function b) disease of muscle tissue c) severe bacterial infection d) impaired electrical system

c) severe bacterial infection

When treating a trauma patient who is in shock, LOWEST priority should be given to a) spinal protection b) thermal management c) splinting fractures d) notifying the hospital

c) splinting fractures

A patient with neurogenic shock would be LEAST likely to present with a) tachypnea b) hypotension c) tachycardia d) altered mentation

c) tachycardia

Whereas the majority of oxygen is carried to the tissues attached to hemoglobin, carbon dioxide can be transported in the blood from tissues back to the lungs in all of the following except a) Dissolved in the plasma b) Combined with water in the form of bicarbonate c) Attached to hemoglobin d) Attached to leukocytes

d) Attached to leukocytes

What would cause nonhemorrhagic hypovolemic shock? a) Ruptured aneurism b) Heart attack c) Spinal cord injury d) Burns

d) Burns

What layer in the abdomen is outermost, in contact with the abdominal wall? a) Peritoneal space b) Visceral peritoneum c) Visceral pleura d) Parietal peritoneum

d) Parietal peritoneum

What treatment should an object that's impaled in the abdomen receive? a) Remove the object to avoid further damage to organs and leave open to the air b) Remove the object and cover with a nonporous dressing. c) Cut the object off close to the abdomen d) Stabilize the object and dress the wound around it

d) Stabilize the object and dress the wound around it

To protect vital organs, the body shunts blood flow from organs that are more tolerant to less blood perfusion. Which of the following? a) skin b) intestines c) lungs d) a and b

d) a and b

This occurs when an open wound through the abdominal wall allows abdominal contents, usually the small intestine to protrude and be exposed. This is most commonly associated with a penetrating injury a) penetrating trauma b) laceration c) hernia d) abdominal evisceration

d) abdominal evisceration

What is sudden cardiac arrest resulting from blunt force chest trauma called? a) tension pneumothorax b) pericardial tamponade c) aortic rupture d) commotio cortis

d) commotio cortis

Bleeding from injury to the female genitalia can be controlled by: a) moist compresses b) cold packs c) packing the vagina d) direct pressure with a moist compress

d) direct pressure with a moist compress

What is an open wound to the abdomen through which organs are protruding? a) penetrating trauma b) laceration c) hernia d) evisceration

d) evisceration

What type of shock is most commonly associated with abdominal trauma? a) hypovolemic shock b) metabolic shock c) psychogenic shock d) hemorrhagic shock

d) hemorrhagic shock

A 20-year-old man was kicked numerous times in the abdomen during an assault. His abdomen is rigid and tender, his heart rate is 120 beats/min, and his respirations are 30 breaths/min. You should treat this patient fo a) a lacerated liver b) a ruptured spleen c) respiratory failure d) hypovolemic shock

d) hypovolemic shock

A pulmonary contusion can be simply defined as bleeding within the: a) potential space b) pericardial sac c) mediastinum d) lung tissue

d) lung tissue

This often seen in young males (mean age is 13 years) with no underlying cardiac disease during sporting events in which a projectile such as a baseball strikes the patient in the center of the chest, causing ventricular fibrillation and cardiac arrest (sudden death) a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade I) cardiac contusion

g) commotio cordis

Because this sac cannot expand outward very much with the filling blood, the result is inward compression of the heart. The compression of the ventricles prevents adequate ventricular filling leading to a reduction in preload, stroke volume, and cardiac output. A reduction in cardiac output leads to hypotension. Because blood flow into the right side of the heart flows against greater resistance, the venous pressure increases, causing distention of the jugular veins and other peripheral veins. What is this condition? a) pulmonary contusion b) cardiac contusion c) open pneumothorax d) tension pneumothorax e) hemothorax f) traumatic asyphxia g) commotio cordis h) pericardial tamponade I) cardiac contusion

h) pericardial tamponade

A sudden drop in the systolic blood pressure by greater than 10 mmHg during inhalation can be another sign of a tension pneumothorax or pericardial tamponade. The drop in systolic blood pressure during inhalation is referred to as _________

pulsus paradoxus

During inhalation, the diaphragm moves lower by as much as _______ inches

three