Chapter 29

The phrenic nerves control the diaphragm and exit the spinal cord at

C3, C4, and C5.

Pneumothorax is defined as:

accumulation of air in the pleural space.

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:

aggressively manage his airway.

Patients with rib fractures will commonly

breathe rapidly and shallowly.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

collapsed jugular veins.

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?

engorged jugular veins

A spontaneous pneumothorax would MOST likely occur as the result of:

exertion of a person with a congenital lung defect.

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:

immediately request ALS support.

The ________ nerves control the diaphragm

phrenic

Pleural fluid is contained between the

visceral and parietal pleurae.

A flail chest occurs when:

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:

administer oxygen and transport to the hospital.

An open pneumothorax occurs when

air enters the pleural space from outside the body

Subcutaneous emphysema is an indication that:

air is escaping into the chest wall from a damaged lung.

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 unconscious, 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:

laceration of the aorta

When a person is lying supine at the end of exhalation, the diaphragm:

may rise as high as the nipple line

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will decrease.

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

must increase his or her respiratory rate to maintain adequate minute volume.

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

myocardial contusion.

A spinal cord injury at the level of C7 would MOST likely result in

paralysis of the intercostal muscles

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:

pleurisy

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:

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 applying 100% oxygen, you should:

prepare for immediate transport.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

provide some form of positive-pressure ventilation.

A patient who presents with profound cyanosis following a chest injury:

requires prompt ventilation and oxygenation.

When assessing a patient with a hemothorax, you will MOST likely find:

signs and symptoms of shock

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

Very young children tend to breathe predominantly with their diaphragm because:

their intercostal muscles are not fully developed.

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

traumatic aortic rupture

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred?

ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle