chapter 30 chest injury EMT!!

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

C3, C4, and C5

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

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 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

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 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.

Subcutaneous emphysema is an indication that:

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

An open pneumothorax is:

an open chest wound through which air moves during breathing.

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.

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.

Hemoptysis is defined as:

coughing up blood

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

diaphragm

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

hematemesis.

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 most critical treatment for a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space

A simple pneumothorax:

is commonly caused by blunt chest trauma.

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 mostsuspicious that this patient has experienced a:

laceration of the aorta.

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

lungs

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

might 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 only inhales 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 mostsuggestive of a:

myocardial contusion.

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 reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing.

The ________ nerves supply the diaphragm.

phrenic

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

pleurisy

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 providing supplemental oxygen, you should:

prepare for immediate transport.

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 bag valve mask.

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

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.

Pleural fluid is contained between the:

visceral and parietal pleurae.