Chapter 34

Assessment findings of a patient ejected from a motorcycle indicate that he has a flail chest wall segment to his right anterior chest. He exhibits labored breathing and an SpO2 at​ 94%. Breath sounds are clear and equal bilaterally. The segment has been​ stabilized, and you are prepared to start positive pressure ventilation. Given these assessment​ findings, what type of injury underlying the flail segment is your primary​ concern? A. Pneumothorax B. Pulmonary contusion C. Hemothorax D. Rib fractures

B. Pulmonary contusion

On​ follow-up, the ED physician informs you that a patient you transported earlier was found to have a hemothorax. You would understand this is a condition in​ which: A. fluid and blood collected around the heart. B. blood collected in the chest. C. the pleural membranes were punctured by a rib. D. the trachea was torn.

B. blood collected in the chest.

A young boy has an open chest wound to the left lateral area after falling off of his bike onto a metal spike in the ground. His family is present and very upset and crying. As an​ EMT, you recognize that in this​ situation, your primary focus​ is: A. providing emotional support. B. maintaining oxygenation. C. controlling pain. D. preventing potential wound infection.

B. maintaining oxygenation.

Care for an open chest wound and an abdominal evisceration are similar in​ that: A. air must be periodically released from both wounds. B. occlusive dressings are placed over both wounds. C. both wounds can cause the trapping of air in the body. D. moist dressings are placed over both wounds.

B. occlusive dressings are placed over both wounds.

A​ 39-year-old male has a single stab wound to the anterior chest. When notifying the emergency​ department, you inform them that the patient is suffering from​ a(n): A. evisceration. B. open chest injury. C. laceration. D. flail chest.

B. open chest injury.

During the secondary​ assessment, the EMT notes instability and a flail segment to a​ patient's lower left lateral chest. The EMT would​ immediately: A. stabilize the segment with his hand. B. start positive pressure ventilation. C. apply bulky dressings to the area. D. auscultate breath sounds.

A. stabilize the segment with his hand.

Assessment findings on a​ 33-year-old female who has been shot in the right side of the chest indicate that she is suffering from a pneumothorax. As you care for this​ patient, your primary concern is monitoring the injury​ for: A. tension pneumothorax. B. infection at the wound site. C. sucking sound at the wound site. D. arterial bleeding.

A. tension pneumothorax.

An adult female is found unresponsive after being shot in the chest. Which statement made by your partner is of most​ concern? A. ​"She is getting more difficult to​ ventilate." B. ​"I do not think her jugular veins are​ distended." C. ​"Her SpO2 has gone from​ 90% to​ 93%." D. ​"I see an entry wound but cannot find the exit​ anywhere."

A. ​"She is getting more difficult to​ ventilate."

When assessing a patient who sustained blunt trauma to the​ chest, what assessment finding is most indicative of an injury to the​ lung? A. Elevated heart rate and blood pressure B. Ability to speak a few words and then gasp C. Extensive bruising to the anterior chest D. Respiratory rate of 20 breaths per minute

B. Ability to speak a few words and then gasp

On​ scene, a paramedic directs you to help another EMS crew with a patient who was hit by a passenger van that ran into a crowd. As you approach the​ patient, what scene​ size-up clue seemingly indicates that the patient is suffering from traumatic​ asphyxia? A. Bilateral femur deformity B. Bluish discoloration to the neck and face C. Wound to the chest making a sucking sound D. Abdominal bruising and distention

B. Bluish discoloration to the neck and face

An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs​ when: A. the trachea becomes​ obstructed, causing the lungs to collapse. B. the lung becomes overinflated with air and collapses. C. air accumulates around the​ lung, causing a portion of it to collapse. D. air enters the lung and alveoli from a traumatic opening in the chest wall.

C. air accumulates around the​ lung, causing a portion of it to collapse.

You have applied a nonporous dressing to a stab wound on a​ patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides and not all four. Your best response is that taping the dressing on three​ sides: A. decreases the chance of air entering the chest on exhalation. B. permits oxygen to still enter the lungs. C. allows trapped air to escape on exhalation. D. causes less pain for the patient.

C. allows trapped air to escape on exhalation.

A construction foreman was stabbed with a screwdriver in the right anterior chest by an angry employee. Prior to your​ arrival, he removed the screwdriver. He is alert and oriented and complaining of pain to the injury site. Your primary assessment reveals an open​ airway, adequate​ breathing, and strong radial pulse. Based on these​ findings, which of the following would be done​ first? A. Evaluate the patient SpO2 level. B. Open the airway using the​ jaw-thrust maneuver. C. Take manual​ in-line spinal stabilization. D. Insert a nasopharyngeal airway.

A. Evaluate the patient SpO2 level.

A​ 23-year-old female has been involved in a serious motor vehicle collision. Which assessment finding best indicates that she has a flail​ segment? A. Paradoxical chest wall movement B. Intense pain with inspiration C. Decreasing SpO2 reading D. Shortness of breath

A. Paradoxical chest wall movement

Which of the following best describes a flail​ segment? A. Two or more adjacent ribs broken in two or more places B. Multiple rib fractures that have bruised the underlying lung C. Multiple fractures to the rib cage caused by blunt trauma D. Fractured ribs that have collapsed the underlying lung

A. Two or more adjacent ribs broken in two or more places

A​ middle-aged male has been stabbed once in the left anterior chest. His airway is​ patent, respirations​ tachypneic, pulse weak and​ rapid, and skin cool and diaphoretic. Breath sounds are clear and equal bilaterally. The vital signs​ are: pulse​ 140, respirations​ 24, blood pressure​ 100/78 mmHg, and SpO2 ​ 96% on supplemental oxygen. Given this​ presentation, you would have a high index of suspicion​ for: A. hemothorax. B. pericardial tamponade. C. flail segment. D. pneumothorax.

B. pericardial tamponade.

Which statement made by an EMT demonstrates an understanding of chest​ trauma? A. ​"Open chest injuries are more serious than closed chest injuries because air and bacteria can enter the chest through the open​ wound." B. ​"Closed chest injuries are caused by blunt trauma and can be just as serious as open chest​ injuries." C. ​"In general, an open chest injury caused by blunt trauma is more life threatening than a closed one due to increased potential for blood​ loss." D. ​"Closed chest injuries are caused by penetrating trauma and cause more​ life-threatening injuries than do open chest​ injuries."

B. ​"Closed chest injuries are caused by blunt trauma and can be just as serious as open chest​ injuries."

On scene at a college football​ game, a wide receiver is unresponsive after colliding with another player and forcefully taking a helmet to the chest. The athletic trainer reports that the patient is pulseless and apneic. Given the mechanism of injury and​ patient's presentation, which instruction would be​ appropriate? A. ​"Someone start positive pressure ventilation while I check for a blood​ pressure." B. ​"Let's apply the AED and follow all​ prompts." C. ​"Before we do​ anything, we need to immobilize​ him." D. ​"Use the AED but no CPR so we do not worsen the potential chest​ injury."

B. ​"Let's apply the AED and follow all​ prompts."

A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary​ assessment, which of the following signs​ and/or symptoms would concern you that she is suffering from a tension​ pneumothorax? A. Absent breath sounds on the​ right, tracheal deviation to the​ right, cyanosis B. Respiratory​ distress, absent breath sounds on the​ left, flat neck​ veins, tachycardia C. Absent breath sounds on the​ right, distended neck​ veins, tracheal deviation to the left D. Absent breath sounds on the​ left, hypotension, SpO2 at​ 98%, bradycardia

C. Absent breath sounds on the​ right, distended neck​ veins, tracheal deviation to the left

You have been called to a New​ Year's party for a male patient who was stabbed in the anterior chest. According to​ partygoers, the patient went outside with another male and was stabbed. Fifteen minutes​ later, he was found in the snow and 911 was called. When assessing this​ patient, what finding would you consider most serious and warrant immediate​ attention? A. Capillary refill of 3 seconds B. Pain and bruising to the left thigh C. Decreased breath sounds to the left lung D. Complaint of a worsening headache

C. Decreased breath sounds to the left lung

When assessing a​ patient, which sign or symptom is most indicative of a​ pneumothorax? A. Intense pain with each inspiration B. SpO2 of​ 90% on​ high-concentration oxygen C. Decreased breath sounds to the right lung D. Crepitus and instability to the chest wall

C. Decreased breath sounds to the right lung

A patient has sustained an injury to his mediastinum. Based on the anatomy of his​ chest, which one of the following structures has been​ injured? A. Diaphragm B. Lungs C. Esophagus D. Bronchus

C. Esophagus

A confused​ 62-year-old female fell at​ home, hitting the side of a table with her chest. Assessment reveals instability to the left lateral chest accompanied by minor bruising in the same area. She complains of intense pain every time she breathes. Her airway is​ patent, breathing is rapid and​ shallow, and skin warm and nondiaphoretic. Vital signs are pulse​ 112, respirations​ 24, and blood pressure​ 132/64 mmHg with SpO2 at​ 90%. Breath sounds are shallow but equal to both lungs. Based on those​ findings, you should treat this patient for what​ life-threatening condition? A. Shock B. Pain C. Hypoxia D. Pneumothorax

C. Hypoxia

You are transporting a young and healthy female patient who was involved in a motor vehicle collision and struck her chest on the steering column. Although the primary assessment reveals no life​ threats, she does have redness to her​ sternum, as well as pain and tenderness. Breath sounds are clear and present bilaterally and vital signs are within normal limits. As you transport and reassess​ her, what sign or symptom would be most​ concerning? A. New complaint of leg pain B. Increased tenderness over sternum C. Onset of an irregular heartbeat D. Development of bruise over sternum

C. Onset of an irregular heartbeat

Damage to tissues of what thoracic​ structure(s) will cause impairment of ventilation and a​ pneumothorax? A. Trachea B. Pulmonary arteries C. Pleural membranes D. Mediastinum

C. Pleural membranes

A young male patient is​ self-extricated after hitting a telephone pole and rolling his car several times at a high rate of speed. He is spitting blood and has a large area of tenderness and instability to the left side of his chest. On scene you did not observe any paradoxical motion of the chest wall. The patient remains alert and oriented with stable vital​ signs, but continually complains of painful breathing. During​ transport, what is it essential that you​ do? A. Place a nonporous dressing and ice packs to the injured area. B. Apply bulky dressings to the area of chest injury. C. Reassess for paradoxical motion of the chest wall. D. Start positive pressure ventilation with supplemental oxygen.

C. Reassess for paradoxical motion of the chest wall.

An unrestrained female driver hit a utility pole at a moderate rate of speed and struck the steering wheel with her chest. Her airway is​ open, and she states that it is painful to breathe. Her pulse is moderate in strength and irregular. Breath sounds are equal​ bilaterally, and there is no jugular venous distention noted. Assessment of her chest reveals bruising and instability to the sternum. When​ asked, she denies any past medical history. Based on this mechanism and assessment​ findings, the EMT should be suspicious for what​ condition? A. Traumatic asphyxia B. Pneumothorax C. Tension pneumothorax D. Cardiac contusion

C. Tension pneumothorax

You are on the scene of a shooting. Your assessment reveals a​ 23-year-old male who has been shot twice. The first wound is to the left lower quadrant of the abdomen and is actively bleeding. The second wound is to the left lateral chest and bubbles every time the patient takes a breath. Your immediate action would​ be: A. obtain a sterile dressing and cover the chest wound. B. place the patient on​ high-concentration oxygen with a nonrebreather face mask. C. cover the chest wound with a gloved hand. D. place direct pressure over the abdominal gunshot wound.

C. cover the chest wound with a gloved hand.

A patient has been shot in the chest with a rifle. Assessment reveals a deteriorating level of consciousness and inadequate breathing. Positive pressure ventilation is being​ administered, and the entrance​ wound, located midclavicular at the second intercostal space on the left side of the​ chest, has been covered. Your next action would be​ to: A. get a full set of vital signs. B. check the blood pressure. C. look for an exit wound. D. place a cervical collar.

C. look for an exit wound.

A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused and breathing rapidly and shallowly. After manually stabilizing the flail section of the chest​ wall, the EMT best treats this condition​ by: A. inserting an oropharyngeal airway. B. applying ice packs to the flail segment. C. providing positive pressure ventilation. D. administering oxygen through a nonrebreather face mask.

C. providing positive pressure ventilation.

A patient has been involved in a motorcycle crash and has a flail segment to the right lateral chest. His airway is open and he is breathing poorly at 24 breaths per minute with a decreasing SpO2. The EMT shows that he is appropriately caring for this injury when​ he: A. administers oxygen through a nonrebreather face mask. B. positions the patient in a​ semi-Fowler's position for transport. C. starts positive pressure ventilation. D. places an ice pack over the site of injury.

C. starts positive pressure ventilation.

The​ EMT's primary and first concern with any open injury to the chest​ is: A. checking for intercostal muscle damage. B. evaluating for crepitus. C. stopping air entry. D. controlling internal bleeding.

C. stopping air entry.

You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. What action is critical given this​ situation? A. Ensure that all four sides of the dressing are taped. B. Remove the occlusive dressing. C. Gently apply pressure to the chest during inspiration. D. Lift one side of the dressing during expiration.

D. Lift one side of the dressing during expiration.

An alert and oriented young male fell 5 feet from a​ stage, impacting a metal railing with the right side of his​ chest, just under his armpit. The primary assessment is negative for life​ threats, although he does complain of very painful breathing and has remarkable tenderness and crepitus over the 5th rib laterally in this area. Throughout​ care, what action is essential to​ perform? A. Splint site with a bulky dressing. B. Administer aspirin for pain. C. Apply ice to area. D. Monitor breath sounds.

D. Monitor breath sounds.

What mechanism of injury produces the conditions for traumatic​ asphyxia? A. Person strangled but not killed in an attempted rape B. Penetrating chest trauma with a​ high-powered firearm C. Fall 20 feet from scaffolding onto a concrete sidewalk D. Person pinned between a truck and wall of a building

D. Person pinned between a truck and wall of a building

You suspect a trauma patient to be suffering from a hemothorax to the left lung. What assessment finding would reinforce this​ suspicion? A. Bradycardia and hypertension B. Cyanosis and a blood pressure of​ 210/100 mmHg C. Neck vein distention and absent breath sounds to the right lung D. Respiratory distress and the signs and symptoms of shock

D. Respiratory distress and the signs and symptoms of shock

A​ 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still​ impaled, and he is complaining of shortness of breath. When he speaks he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which one of the following should you do​ first? A. Provide positive pressure ventilation. B. Remove the knife and seal the injury with a dressing. C. Stabilize the knife with bulky dressings. D. Suction the blood from the airway.

D. Suction the blood from the airway.

A paramedic has asked that you apply a dressing over a sucking chest wound. What is best to cover the​ injury? A. Dry sterile gauze dressing B. Clean washcloth C. Sterile gauze soaked in sterile water D. Vaseline gauze

D. Vaseline gauze

You are transporting a​ 19-year-old male with a gunshot wound to the chest. On scene you covered the wound with an appropriate dressing.​ Now, as you reassess the​ patient, you note that the patient is tachypneic and complaining of difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be​ to: A. provide positive pressure ventilation with​ high-concentration oxygen. B. tape the dressing on the fourth side. C. cover the wound with another dressing. D. lift the dressing from the wound for several seconds.

D. lift the dressing from the wound for several seconds.

An unrestrained​ 32-year-old female motorist hit a utility pole head on at 45 mph. The car sustained extensive damage. She has an open​ airway, breathing poorly at 32 breaths per​ minute, and is responsive to painful stimuli. The radial pulse is rapid and​ weak, and her skin is cool and cyanotic. Breath sounds are decreased on the right side. Emergency Medical Responders are maintaining manual​ in-line stabilization. Your next action would be​ to: A. examine the patient for additional injuries. B. place a cervical collar and immobilize her. C. palpate the chest wall for instability. D. start positive pressure ventilation.

D. start positive pressure ventilation.

The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes what​ statement? A. ​"A tension pneumothorax causes blood to accumulate around the​ lung; a pneumothorax involves the accumulation of only air around the​ lung." B. ​"A pneumothorax is caused by a closed chest​ injury; a tension pneumothorax is caused by an open chest​ injury." C. ​"A pneumothorax describes a collapsed​ lung; a tension pneumothorax involves both a collapsed lung and blood​ loss." D. ​"A tension pneumothorax causes cardiac output to​ decrease; a simple pneumothorax does not affect cardiac​ output."

D. ​"A tension pneumothorax causes cardiac output to​ decrease; a simple pneumothorax does not affect cardiac​ output."