Chapter 29 Chest injuries EMT School

Commotio cordis

A blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a person's heartbeat.

hemothorax

A collection of blood in the pleural cavity.

flail chest

A condition in which three or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage.

flutter valve

A one-way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve; may also be part of a commercial vented occlusive dressing.

traumatic asphyxia

A pattern of injuries seen after a severe force is applied to the chest, forcing blood from the great vessels back into the head and neck

spontaneous pneumothorax

A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space

tension pneumothorax

An accumulation of air or gas in the pleural space that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.

When a patient sustains a spinal cord injury above the C3 region, which of the following is likely to happen?

An injury above C3 is likely to cause the patient to lose his/her ability to breathe entirely.

sucking chest wound

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound. See also open pneumothorax.

simple pneumothorax

Any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient.

Which of the following blood vessels can be lacerated by a fractured rib?

Aorta

Myocardial Contusion

Bruising of the heart muscle

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

C3, C4, and C5

cardiac tamponade (pericardial tamponade)

Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.

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

In which condition is it recommended you use positive-pressure ventilation?

Flail chest

Tachypnea

Increased respiratory rate

pulmonary contusion

Injury or bruising of lung tissue that results in hemorrhage

Two most common injuries caused by penetrating chest trauma?

Open pneumothorax and cardiac tamponade

You are treating a patient who fell hard on her right side when she fell off a bike. Exposure of the patient's chest reveals a large bruise on the lateral aspect of the right side of the chest. When you palpate the area, the patient yells out in extreme pain and states that she cannot take a deep breath. What condition should you suspect?

Rib fractures

What is the best position in which to place a patient when you want to assess for jugular vein distention?

Sitting at a 45 degree angle

hemopneumothorax

The accumulation of blood and air in the pleural space of the chest.

pericardium

The fibrous sac that surrounds the heart.

paradoxical motion

The motion of the portion of the chest wall that is detached in a flail chest; the motion—in during inhalation, out during exhalation—is exactly the opposite of normal chest wall motion during breathing

On inhalation, which of the following does NOT occur?

The pressure inside the chest increases.

What is ventilation?

Ventilation is the body's ability to move air in and out of the chest and lung tissue.

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

A flail chest occurs when:

a segment of the chest wall is detached from the thoracic cage.

Pneumothorax is defined as:

accumulation of air in the pleural space.

While jogging, a 19 year old male experienced an acute onset 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

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.

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.

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

A sucking chest wound should be treated with:

an occlusive dressing

Which of the following is most likely to cause immediate death?

aortic rupture

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:

assist ventilations with a bag-valve mask.

Closed chest injuries are typically caused by _______.

blunt trauma

Closed chest injuries are typically caused by ________?

blunt trauma

Patients with rib fractures will commonly:

breathe rapidly and shallowly.

The trachea divides into the right and left main stem ____

bronchi

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

collapsed jugular veins.

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:

commotio cordis

During inhalation, the pressure in the chest ______.

decreases

The ____ separates the thoracic cavity from the abdominal cavity

diaphragm

The thoracic cavity is separated from the abdominal cavity by the:

diaphragm.

The thoracic cavity is separated from the abdominal cavity by the:

diaphram

Large blood vessels in the chest that can result in massive hemorrhaging include all of the following EXCEPT:

femoral arteries

Paradoxical motion is a sign of a _______.

flail chest

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

hematemesis.

You are assessing a patient and notice he has a collapsed jugular vein. What does this indicate?

hemothorax

You are assessing a patient who sustained a blunt force chest injury during a motorcycle accident. There are no obvious signs of external bleeding, but the patient is hypovolemic and there are decreased breath sounds on the left side. Which of the following should you suspect?

hemothorax

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 breath sounds. As your partner is supporting her ventilations, you should:

immediately request ALS support

The pliability of the pediatric rib cage _______.

increases the risk of internal injury

The treatment for relieving a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space.

Traumatic asphyxia:

is a sudden, severe compression of the chest

You arrive at the scene of a major motor vehicle crash. The patient, a 50 year old female, was removed form 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:

laceration of the aorta

Hemoptysis indicates damage to the _______.

lungs

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

may rise as high as the nipple line

The esophagus, trachea, and great vessels reside in the _______.

mediastinum

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

minute volume will decrease.

A _____ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms.

myocardial contusion

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

The ____ lines the inner chest wall.

parietal pleura

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:

partially remove the dressing.

The ________ nerves control the diaphragm.

phrenic

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

pleurisy.

In order to avoid exacerbating a patients 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 providing supplemental oxygen, you should:

prepare for immediate transport

Immediately life-threatening chest injuries must be found and managed during the _________?

primary assessment

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

provide ventilation assistance with a BVM.

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 saturations is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:

pulmonary contusion

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:

pulmonary contusion.

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

signs and symptoms of shock.

Patients with chest injuries will often present with _______.

tachypnea

Patients with chest injuries will often present with _______?

tachypnea

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

Children are often "belly breathers" because _______.

their intercostal muscles are not developed

Children are often "belly breathers" because _________?

their intercostal muscles are not developed

Air is supplied to the lungs via the:

trachea

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

traumatic aortic rupture.

Paradoxical motion of the chest refers to:

unequal expansion of the chest wall

The body's ability to move air in and out of the lungs is called _______.

ventilation

Pleural fluid is contained between the:

visceral and parietal pleurae.

crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

pneumothorax

A partial or complete accumulation of air or gas in the pleural space

occlusive dressing

An airtight dressing that protects a wound from air and bacteria; a commercial vented version allows air to passively escape from the chest, while an unvented dressing may be made of petroleum jelly-based (Vaseline) gauze, aluminum foil, or plastic.

open chest injury

An injury to the chest in which the chest wall itself is penetrated by a fractured rib or, more frequently, by an external object such as a bullet or knife.

closed chest injury

An injury to the chest in which the skin is not broken, usually caused by blunt trauma.

open pneumothorax

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound.

Which of the following is most likely to cause immediate death?

Aortic rupture

Distended jugular veins, narrowing pulse pressure, and muffled heart tones are collectively known as _______.

Beck's triad

You are transporting a stable patient with a possible pneumothorax. The patient is receiving high-flow oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient's deterioration?

Compression of the aorta and vena cava

________ in a patient with a chest injury is a sign that the blood is not being oxygenated sufficiently.

Cyanosis

You respond to the local rodeo arena for a bull rider. The scene is safe, and the patient is lying unconscious in the middle of the arena. His airway is open, and he is breathing 20 breaths/min and blood pressure is 110/64 mm Hg. There is no obvious bleeding. Bystanders tell you he was thrown into the air and landed on the bull's head. He was not wearing a vest. Which of the following is NOT indicated in blunt trauma to the chest.

Dissection of the carotid arteries

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

Which of the following regarding hemothorax is correct?

It can only be treated by a surgeon

Which of the following organs or structures does NOT reside within the mediastinum?

Lungs

A patient with a chest injury has a blood pressure of 100/60 mm Hg and a pulse rate of 120 beats/min. Which of the following additional findings should make you suspect a pericardial tamponade?

Repeat BP of 90/68 mm Hg

Common signs and symptoms of tension pneumothorax include all of the following EXCEPT:

high blood pressure

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.

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:

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.

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

paralysis of the intercostal muscles.

You have sealed the open chest wound of a 40 year old male who was stabbed in the anterior chest. Your assessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing.

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.

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:

prepare for immediate transport.

Immediately life-threatening chest injuries must be found and managed during the _______.

primary assessment

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

requires prompt ventilation and oxygenation.

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:

rib fractures

You respond to a 20-year-old man who was playing basketball and suddenly developed chest pain and respiratory difficulty. He is alert and oriented and complaining of chest pain. He is breathing at 24 breaths/min. His pulse is 140 beats/min and BP is 160/90 mm Hg. When listening to the chest, you notice diminished breath sounds on the left side. This patient is most likely suffering from a

simple pneumothorax

Distending jugular veins, a narrowing pulse pressure, and muffled heart sounds are seen in which of the following conditions?

Cardiac tamponade

Which of the following is NOT a sign or symptom of a chest injury?

Clear and equal breath sounds

Which of the following is NOT a pertinent negative to note during your assessment of a patient with chest trauma?

No heart murmurs

_____ can increase intrathoracic pressure reducing cardiac output and potentially worsening injuries such as pneumothorax.

Overventilation

You respond to a motor vehicle collision and find a 29-year-old woman who is complaining of chest pain. Her chest struck the steering wheel. her airway is open, she is breathing at 24 breaths/min and she is coughing up blood. Her pulse is 130 beats/min, rapid and weak, and her BP is 90/58 mm HG. You notice cyanosis around the lips and note that her fingers are also blue. When you expose the chest, she tells you it hurts and points to a bruised spot. Which of the following is a symptom

Pain at the site of injury

A simple pneumothorax:

is commonly caused by blunt chest trauma

A simple pneumothorax:

is commonly caused by blunt chest trauma.

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.

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.