EMT BradyLab Chapter 27

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A fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment is called​ a:

flail chest.

A movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity is​ called:

paradoxal motion

Which of the following is an accurate description of a flail​ chest?

section of the chest wall that is unstable, leading to breathing problems

A weak or absent radial​ pulse; pale,​ moist, cool​ skin; and an increased heart rate in a patient with an abdominal injury are signs​ of:

shock

Blunt abdominal trauma that causes the perforation of a vascular structure in the abdomen may​ cause:

significant blood loss.

A drawback to using sterile aluminum foil as an occlusive dressing​ is:

skin lacerations may occur from the sharp edges

Injury to which of the following organs would be MOST likely to cause​ peritonitis?

small intestine

Blunt trauma resulting in a closed chest injury creates the potential for which of the following​ injuries?

Contusion

Which of the following is LEAST likely to indicate abdominal​ injuries?

Contusions to the shoulders.

Why is it so important to seal holes in the chest from penetrating trauma as early as​ possible?

The lungs will collapse if air gets between the two pleural membranes.

​You're an​ off-duty EMT who encounters a patient sitting behind the wheel of a vehicle that ran off the road along an isolated county road. It appears the patient was​ unrestrained, or not wearing a seat​ belt, and struck the steering wheel with his chest. On​ assessment, you notice a paradoxical motion to the​ patient's chest on inspiration and expiration. When you radio for dispatch of an​ ambulance, which of the following pieces of information would you be sure to​ include?

The patient may have a flail chest.

What is the purpose of a​ three-sided occlusive​ dressing?

To allow air to escape but not enter

You are stabilizing a patient who has just been stabbed in the chest to the right of the mediastinum. After placing the patient on supplemental​ oxygen, his shortness of breath resolves. You also cover the wound with an occlusive dressing. The patient is asymptomatic at the time​ you're making the decision to transport. Which of the following BEST encapsulates the correct strategy for​ transport?

Transport the patient emergently because of the high index of suspicion for a serious injury.

For a patient who has gunshot wounds in the lower ribs and at the same level in the​ back, which of the following statements is​ TRUE?

You need to treat the patient for both chest and abdominal wounds.

Which of the following statements is TRUE about a compression​ injury?

a mechanism of injury involving a compression injury is a driver striking his chest on a steering column

Which of the following is the LEAST reliable sign for determining the presence of a tension​ pneumothorax?

trachea that shifts to the side opposite the injury

Your patient was working on a car when it fell off the jack and trapped him between the tire and ground. His face is very blue and his eyes are bloodshot. Which of the following has the patient most likely​ suffered?

traumatic asphyxia

You are treating a​ 42-year-old male assault victim who presents with​ nausea, vomiting, and sharp abdominal pain. While inspecting his​ abdomen, you note redness to his right upper quadrant. Based on your assessment​ findings, the patient is MOST likely suffering from which of the​ following?

traumatic hemorrhage of the liver

The chest cavity can hold up to​ ________ liter(s) of blood in an​ adult, leading to the possibility of massive internal hemorrhage without any external blood loss.

3

You are caring for a​ 27-year-old male who has a puncture wound to the right upper chest. The patient was stabbed with a serrated steak knife by his​ ex-girlfriend. You have begun direct pressure to the site but lack an occlusive dressing to place over the wound. What is your LEAST acceptable option for dressing the​ wound?

Aluminum foil

You are treating a patient who was stabbed in the right side of the anterior chest wall. He has shortness of​ breath, weakness, and rapid breathing. Aside from administering​ oxygen, what is the MOST appropriate treatment for this​ patient?

Apply an occlusive dressing on the chest​ wall, and tape the dressing on three sides.

A patient with an abdominal injury will likely want to keep the legs in what position to reduce​ pain?

Bent

Which of the following statements is​ TRUE?

Bullet wounds are a type of penetrating trauma and involve both internal and external injuries.

You suspect that your patient has a tension pneumothorax. During patient​ assessment, which of the following findings would MOST lead to this​ suspicion?

Diminished or absent lung sounds on side affected by​ trauma; jugular venous​ distention; signs of shock

On assessment of the midsection of a​ 32-year-old male who was struck by a​ car, you find an abdominal evisceration with several loops of his large intestine exposed. The abdomen appears to have a​ clean-cut laceration and the bleeding is controlled. Which of the following is the BEST approach toward managing the exposed​ intestines?

Moisten a sterile dressing with saline solution and cover the abdominal contents.

Which of the following BEST describes an​ evisceration?

Open wound of the abdomen from which organs protrude

While assessing the abdomen of a​ 25-year-old female, you note that she has a large piece of glass sticking out of her right upper quadrant. What should you​ do?

Stabilize the glass.

An open chest wound that pulls air into the thoracic cavity is known as what type of​ injury?

Sucking

What is the correct terminology for a wound in which a vacuum has been created within the​ chest, drawing air into the thorax with each​ breath?

Sucking chest wound

Which of the following is MOST clearly an example of an open chest​ injury?

Sucking chest wound

Which of the following describes the proper application of an occlusive dressing for an open chest​ wound?

Tape the dressing securely on three sides.

A pneumothorax may occur​ when:

air leaks into the chest cavity from a damaged​ lung, with no opening through the outer chest.

An open abdominal wound with protruding organs is​ called:

an evisceration.

Severe abdominal trauma and blood loss may cause signs and symptoms of​ shock, which​ include:

an increased heart rate.

Some local protocols recommend that an abdominal evisceration should be covered with a sterile dressing moistened with sterile​ saline, followed​ by:

an occlusive dressing.

While palpating the radial pulses of a patient who was involved in a motor vehicle​ crash, you notice a difference in the strength of the pulses bilaterally. This is a finding that you suspect may be associated​ with:

aortic dissection

Which of the following traumatic chest injuries causes​ massive, often fatal internal​ hemorrhage?

aortic injury

You are dispatched to a​ 42-year-old male who was shot in the abdomen and thrown from a vehicle. The patient is critical and a​ high-category trauma;​ however, due to the mechanism of​ injury, it is necessary to backboard the patient prior to transport. What is an important assessment before securing the​ patient?

assessing the patient for an exit as well as an entrance wound

For both open and closed abdominal​ injuries, you​ should:

be alert for vomiting and keep the airway open

Cardiac tamponade occurs​ when:

blood enters the pericardial sac surrounding the heart

What type of injury is likely to produce a flail​ segment?

blunt trauma

Jugular venous distention is MOST likely​ with:

cardiac tamponade

The pathophysiology of​ ________ is one in which the pericardial sac fills with blood to the point where the chambers of the heart no longer fill​ adequately, usually secondary to trauma.

cardiac tamponade

You are on an EMS standby for a boxing tournament. During one of the​ matches, one of the female boxers delivers a forcible uppercut to the chest of her​ opponent, who falls to the ground. The match is declared over on the basis of a TKO.​ However, the opponent fails to arise following a​ one- to​ two-minute interval. EMS is summoned to the ring. You find the patient pulseless and breathing agonal gasps. You suspect which of the following traumatic​ conditions?

commotio cordis

The mechanism of injury in which a​ patient's chest has struck an immovable​ object, such as a steering​ wheel, may most accurately be described as​ a(n):

compression injury

You have covered an open chest wound with your gloved hand and the​ patient's breathing has improved. In order to free your hand to provide further​ care, you​ should:

cover the wound with an occlusive dressing.

What is the underlying cause of​ bluish, purplish, or reddish facial discoloration following a traumatic​ asphyxiation?

high pressure on the chest leads to blood being forced from the right atrium into the face and neck

An injury to the hollow organs in the abdomen typically leads​ to:

inflammation and infection

Common signs and symptoms following an injury to a hollow abdominal organ​ include:

irritation and peritonitis

Which of the following BEST describes the benefit of a​ three-sided occlusive dressing over a​ four-sided occlusive dressing for an open chest​ wound?

it reduces the chances of developing a tension pneumothorax

Which of the following BEST describes an open chest wall​ injury?

knife wound to the left anterior chest

When caring for a patient with an impaled object in the​ abdomen, the EMT​ should:

leave the impaled object in place and stabilize it with bulky dressings

What organ in the abdomen is MOST commonly injured by blunt trauma and can bleed profusely enough to threaten the​ patient's life?

liver

Which of the following is a vascular organ in the abdomen that can produce blood loss quickly enough to result in​ life-threatening hemorrhage following the mechanism of injury of blunt​ trauma?

liver

You arrive on scene to a​ 34-year-old male gunshot victim lying in his living room​ disoriented, pale,​ cool, and diaphoretic with shallow respirations. You note blood on his shirt at the chest and​ abdomen, and the puncture wound appears to be through the chest. What is your FIRST priority in treating this​ patient?

locate the gunshot wound on the chest and place your gloved hand over the injury

In the case of a large​ evisceration, you​ should:

place layers of bulky dressing over a dressing moistened with saline

You find a​ middle-aged male is sitting against a wall in obvious distress. The patient appears to be extremely short of breath and has an open wound to his chest that is making a sucking sound. You should​ IMMEDIATELY:

place your gloved hand over the wound.

When air is present in the chest​ cavity, the injury is called​ a:

pneumothorax

An object that is impaled in the abdomen should​ be:

stabilized in place.

Which of the following is the BEST strategy to maintain the covering of an occlusive dressing placed over an​ evisceration?

tape or cavats tied above and below the position of the exposed organ

A patient with jugular vein distention​ (JVD) is MOST likely suffering from which of the following​ injuries?

tension pneumothorax

A type of pneumothorax in which air that enters the chest cavity is prevented from escaping​ is:

tension pneumothorax

You respond to the scene of a​ 24-year-old gunshot victim and find your patient to have a decreased mental status as well as hypotension. You note absent breath sounds on the left side of his chest where you notice a puncture wound. What is this patient MOST likely suffering​ from?

tension pneumothorax

Which of the following statements regarding the​ skin's status in the case of a closed chest injury is​ TRUE?

the skin is not penetrated


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