Ch. 29 Chest Injuries

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

Correct Response C) paralysis of the intercostal muscles.

The ________ nerves control the diaphragm. A) vagus B) costal C) phrenic D) intercostal

Correct Response C) phrenic

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

Correct Response D) Aortic rupture

The phrenic nerves control the diaphragm and exit the spinal cord at: A) C1 and C2. B) C3 and C4. C) C1, C2, and C3. D) C3, C4, and C5.

Correct Response D) C3, C4, and C5.

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

Correct Response D) immediately request ALS support.

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

Correct Response D) laceration of the aorta.

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

Correct Response D) primary assessment

A patient who presents with profound cyanosis following a chest injury: A) should be placed in Trendelenburg position. B) is most likely experiencing severe blood loss. C) has most likely experienced a ruptured aorta. D) requires prompt ventilation and oxygenation.

Correct Response D) requires prompt ventilation and oxygenation.

Elevation of the rib cage during inhalation occurs when: A) the diaphragm descends. B) abdominal contents descend. C) intrathoracic pressure decreases. D) the intercostal muscles contract.

Correct Response D) the intercostal muscles contract.

A _____ results when an injury allows air to enter through a hole in the chest wall or the surface of the lung as the patient attempts to breathe, causing the lung on that side to collapse. A) tension pneumothorax B) hemothorax C) hemopneumothorax D) pneumothorax

Correct Answer D) pneumothorax

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? A) Engorged jugular veins B) Widening pulse pressure C) Diminished breath sounds D) A rapid, irregular pulse

Correct Response A) Engorged jugular veins

Which of the following organs or structures does NOT reside within the mediastinum? A) Lungs B) Trachea C) Vena cavae D) Esophagus

Correct Response A) Lungs

Which of the following is NOT a pertinent negative to note during your assessment of a patient with chest trauma? A) No heart murmurs B) No associated shortness of breath C) No rapid breathing D) No areas of deformity

Correct Response A) No heart murmurs

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

Correct Response A) a segment of the chest wall is detached from the thoracic cage.

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

Correct Response A) administer oxygen and transport to the hospital.

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds and bilateral scleral hemorrhaging. You should: A) aggressively manage his airway. B) request a paramedic ambulance. C) perform a secondary assessment. D) suspect a severe hemopneumothorax.

Correct Response A) aggressively manage his airway.

You respond to an 18-year-old man who has been assaulted with a baseball bat. He was hit in the chest. He is unresponsive, apneic, and pulseless. This condition is most likely related to: A) commotio cordis. B) cardiac tamponade. C) pneumothorax. D) traumatic asphyxia.

Correct Response A) commotio cordis.

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

Correct Response A) diaphragm.

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

Correct Response A) is commonly caused by blunt chest trauma.

A patient with blunt trauma who is holding the lateral side of his chest and has rapid and shallow respirations is most likely suffering from: A) rib fractures. B) a sternal fracture. C) a pneumothorax. D) a pulmonary contusion.

Correct Response A) rib fractures.

Pleural fluid is contained between the: A) visceral and parietal pleurae. B) parietal pleura and the heart. C) visceral pleura and the lung. D) parietal pleura and the chest wall.

Correct Response A) visceral and parietal pleurae.

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

Correct Response B) air enters the pleural space from outside the body.

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

Correct Response B) may rise as high as the nipple line.

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

Correct Response B) partially remove the dressing.

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

Correct Response B) pneumothorax.

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

Correct Response B) prepare for immediate transport.

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

Correct Response B) pulmonary contusion.

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

Correct Response B) tachypnea

Which of the following is NOT a sign or symptom of a chest injury? A) Bruising of the chest wall B) Crepitus with palpation of the chest C) Clear and equal breath sounds D) Unequal expansion of the chest wall

Correct Response C) Clear and equal breath sounds

On inhalation, which of the following does NOT occur? A) The intercostal muscles contract, elevating the rib cage. B) The diaphragm contracts. C) The pressure inside the chest increases. D) Air enters through the nose and mouth.

Correct Response C) The pressure inside the chest increases.

During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should: A) request a paramedic to decompress the chest. B) make note of it and continue your assessment. C) assist ventilations with a bag-valve mask. D) apply high-flow oxygen via nonrebreathing mask.

Correct Response C) assist ventilations with a bag-valve mask.

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

Correct Response C) blunt trauma

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

Correct Response C) must increase his or her respiratory rate to maintain adequate minute volume.

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

Correct Response D) their intercostal muscles are not developed