Chapter 28- Chest Injuries

As the aorta exits the left ventricle, it immediately branches into the:

coronary arteries.

The primary muscle(s) of respiration is/are the:

diaphragm and intercostal muscles.

When treating a patient with a suspected myocardial contusion, it is especially important to monitor the patient for:

evidence of pulmonary edema.

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

hyperpnea

Regardless of the cause, hyperventilation causes:

respiratory alkalosis.

Which of the following MOST accurately describes the pathophysiology of a pneumothorax?

Intrapleural pressure with progressive pulmonary collapse

Which of the following statements regarding the parietal pericardium is correct?

It cannot distend acutely but can slowly distend with as much as 1,000 mL of blood.

A trauma patient who presents with shock, jugular venous distention, and bilaterally equal breath sounds has MOST likely experienced a:

Pericardial tamponade

Just before striking a tree with her car, a 17-year-old female suddenly gasps and holds her breath. What type of injury will she MOST likely experience?

Rupture of the lung parenchyma

Which of the following mechanisms of injury is MOST commonly associated with traumatic dissection or rupture of the aorta?

Significant falls

Of the following injuries, which would MOST likely present with muffled heart tones?

Tension pneumothorax

A 31-year-old man was stabbed in the chest during an altercation at a bar. He is semiconscious and has shallow breathing. As your partner assists the patient's ventilations, you perform a rapid assessment and find a single stab wound to the left anterior chest with minimal bleeding. Breath sounds on the side of the injury are markedly diminished. You should:

cover the wound with an occlusive dressing and continue your assessment.

A 22-year-old male with blunt thoracic trauma presents with severely labored respirations. His level of consciousness is decreased and his heart rate is 140 beats/min and thready. Further assessment reveals absent breath sounds on the entire left side of his chest and jugular venous distention. After appropriately managing his airway and immobilizing his spine, you should:

transport immediately, start a large-bore IV en route, and request a paramedic rendezvous.

When caring for a patient with significant thoracic trauma and signs of shock, it is MOST important to:

transport promptly to a trauma center.

A 54-year-old male impacted the steering wheel with his chest when his truck struck another vehicle head-on. He complains of retrosternal chest pain, dysphagia, and dyspnea. Although his blood pressure is 160/90, his femoral pulses are weakly palpable. You should suspect:

traumatic aortic disruption

Common clinical findings in a patient with a suspected myocardial contusion include all of the following EXCEPT:

unilaterally diminished or absent breath sounds.

Common clinical findings in a patient with a suspected myocardial contusion include all of the following, EXCEPT:

unilaterally diminished or absent breath sounds.

A 29-year-old male was robbed and struck in the chest by an assailant with a steel pipe. Your assessment reveals severe pain and crepitus to the right upper chest, at and below the clavicle. What is MOST significant about the location of this patient's injury?

Because they are protected by the bony girdle of the clavicle and scapula, upper rib fractures may indicate severe internal injuries.

Which of the following signs or symptoms would you be LEAST likely to find during your assessment of a patient with a pneumothorax?

Contralateral shifting of the trachea

Which of the following is a LATE sign of a tension pneumothorax?

Contralateral tracheal shift

A 40-year-old male experienced penetrating trauma to the left anterior chest. During inhalation, you note that his radial pulses become barely palpable. You should suspect:

cardiac tamponade.

Which of the following statements regarding the lung parenchyma is correct?

It is covered by the visceral pleura

Which of the following chest injuries would be the LEAST likely to present with jugular venous distention?

Massive hemothorax

The mediastinum encompasses all of the structures within the thoracic cavity EXCEPT:

the lungs

What is the rationale for restricting IV fluid boluses in patients with a pulmonary contusion?

Fluids may cause pulmonary edema or increased bleeding

Which of the following statements regarding blunt chest trauma is correct?

Fractured ribs can tear the lung parenchyma or other vital intrathoracic organs

A 37-year-old semiconscious male sustained a stab wound lateral to the left side of the sternum. He presents with signs of shock, engorged jugular veins, and a weakened radial pulse during inspiration. After administering 100% supplemental oxygen, you should:

administer 20 mL/kg boluses of an isotonic crystalloid

When percussing the chest of a patient who experienced blunt chest trauma, you note hyperresonance on the left side of his chest. This suggests:

air in the pleural space

A 37-year-old male sustained blunt trauma to the left anterolateral chest. He is conscious, but confused, and complains of pain during inspiration; his respirations are shallow. Your assessment reveals crepitus to the area of impact. Breath sounds, although weakly audible, are bilaterally equal. The pulse oximeter reads 89% on room air. You should:

assist his ventilations with a bag-mask device.

When treating a patient with a suspected diaphragmatic rupture, you should:

avoid placing the patient in a Trendelenburg position.

A construction worker is pinned in between a truck and a loading dock. He is conscious and in respiratory distress. Further assessment reveals upper torso and facial cyanosis and bilateral conjunctival hemorrhages. When treating this patient, you must:

be prepared for severe hypotension once he is freed

Visceral injuries in the chest that occur from shearing forces, compression, or rupture, are MOST commonly seen with:

blunt chest trauma

A 34-year-old male is in late shock secondary to blunt chest trauma. His respirations of 6 breaths/min and shallow will initially result in:

carbon dioxide retention and acidosis

A 34-year-old male is in late shock secondary to blunt chest trauma. His respirations of 6 breaths/min and shallow will initially result in:

carbon dioxide retention and acidosis.

Unilaterally diminished or absent breath sounds, a narrowed pulse pressure, and dullness to percussion of the hemithorax are clinical findings suggestive of a:

hemothorax.

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

hyperpnea

Commotio cordis is a condition in which:

immediate cardiac arrest occurs when the chest is impacted during the heart's repolarization period.

When administering IV fluids to a patient with suspected intrathoracic bleeding, it is important to remember that:

increasing the BP with fluids may increase the bleeding.

The mediastinum encompasses all of the structures within the thoracic cavity, EXCEPT for the:

lungs

Patients with a tension pneumothorax experience a decreased cardiac output and shock secondary to:

myocardial compression and decreased preload

In contrast to paradoxical chest motion, asymmetrical chest movement occurs when:

one side of the chest fails to move normally during inspiration

Which of the following potentially lethal chest injuries would you be the LEAST likely to detect during the primary assessment?

pulmonary contusion

During your rapid assessment of a patient with a gunshot wound to the chest, you located an open wound to the right anterior chest and sealed it with the appropriate dressing. A few minutes later, the patient's respirations are increasingly labored and his heart rate has significantly increased. You should:

relieve pleural tension by lifting a corner of the dressing.

Chest trauma is a common cause of respiratory acidosis, and rapidly leads to death because the:

renal system cannot compensate quickly enough.

The presence of a scaphoid abdomen and bowel sounds in the lower hemithorax are MOST suggestive of a:

ruptured diaphragm

You are performing a rapid assessment on a 30-year-old male who was involved in a motor-vehicle crash. The patient is conscious, but restless. He complains of difficulty breathing and chest pain. Your assessment reveals diminished breath sounds in the left hemithorax, normal jugular veins, and a midline trachea. His blood pressure is 124/64 mm Hg, heart rate is 120 and regular, and respirations are 26 breaths/min and shallow. Which of the following injuries should you suspect?

simple pneumothorax

Shortly after arriving home from the airport, a 19-year-old male experienced an acute onset of sharp chest pain and difficulty breathing. He denies a history of trauma. Your assessment reveals that he is in moderate distress and is tachycardic. Breath sounds are diminished over the apex of the right lung. You should suspect a/an:

spontaneous pneumothorax

During your rapid assessment of a semiconscious 44-year-old female with blunt thoracic trauma, you detect an area on the left anterior chest that bulges during exhalation. Your partner is assisting her ventilations with a bag-mask device and 100% oxygen. You should:

stabilize the chest wall deformity and continue your assessment.

Following a motor-vehicle crash in which his truck struck a utility pole, a 56-year-old male complains of pain to the mid-chest and difficulty breathing. Your assessment reveals an ecchymotic area over the mid-sternum. His blood pressure is 110/70 mm Hg, pulse is 120 and irregular, and respirations are 24 breaths/min with adequate depth. In addition to spinal immobilization, appropriate treatment for this patient includes:

supplemental oxygen and a large-bore IV set to keep the vein open.

Patients with multiple rib fractures may develop significant hypoxia because of a ventilation/perfusion mismatch, which occurs when:

the circulatory system is intact but the amount of available oxygen is diminished.

Any injury at the nipple line should be considered a thoracic and abdominal injury because:

the diaphragm may elevate as high as the nipple line upon exhalation

The esophagus enters the thorax via the thoracic inlet and travels:

through the posterior thorax.

Fracture of the first and second ribs following severe blunt trauma would MOST likely result in a:

tracheobronchial injury

A 54-year-old male convenience store clerk was shot in the left anterior chest during an attempted robbery. After ensuring that the scene is safe, you enter the store and perform a primary assessment. The patient is semiconscious, is in severe respiratory distress, and is pale. Further assessment reveals absent breath sounds on the left side of his chest, collapsed jugular veins, and a blood pressure of 70/44 mm Hg. In addition to managing his airway, you should:

transport immediately and perform invasive procedures en route.