EMT Chapter 29 - Chest Injuries

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: Select one: A. determine if he has cardiac problems. B. prepare for immediate transport. C. apply an AED and assess his BP. D. apply bulky dressings to the sternum.

B

A simple pneumothorax: Select one: A. often has a nontraumatic cause. B. is commonly caused by blunt chest trauma. C. heals on its own without any treatment. D. is caused by penetrating chest trauma.

B

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? Select one: A. Widening pulse pressure B. Engorged jugular veins C. Diminished breath sounds D. A rapid, irregular pulse

B

Immediately life-threatening chest injuries must be found and managed during the _______. Select one: A. scene size-up B. primary assessment C. secondary assessment D. patient history

B

Signs and symptoms of a chest injury include all of the following, EXCEPT: A. hemoptysis. B. hematemesis. C. asymmetrical chest movement. D. increased pain with breathing.

B

What purpose does a one-way "flutter valve" serve when used on a patient with an open pneumothorax? A. It prevents air escape from within the chest cavity. B. It allows a release of air trapped in the pleural space. C. It only prevents air from entering an open chest wound. D. It allows air to freely move in and out of the chest cavity.

B

When the chest impacts the steering wheel during a motor vehicle crash with rapid deceleration, the resulting injury, which often kills patients, usually within seconds, is: A. a hemothorax. B. aortic shearing. C. a pneumothorax. D. a ruptured myocardium.

B

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: Select one: A. begin ventilatory assistance. B. partially remove the dressing. C. call for a paramedic ambulance. D. begin rapid transport at once.

B

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: Select one: A. massive hemothorax. B. traumatic asphyxia. C. pulmonary contusion. D. tension pneumothorax.

C

During your assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should: A. request a paramedic to decompress the chest. B. make note of it and continue your assessment. C. stabilize the chest wall with a bulky dressing. D. reassess the adequacy of the patient's breathing.

C

Signs of a cardiac tamponade include all of the following, EXCEPT: A. muffled heart tones. B. a weak, rapid pulse. C. collapsed jugular veins. D. narrowing pulse pressure.

C

When caring for a patient with signs of a pneumothorax, your MOST immediate concern should be: A. hypovolemia. B. intrathoracic bleeding. C. ventilatory inadequacy. D. associated myocardial injury.

C

Which of the following is NOT a sign or symptom of a chest injury? A. bruising of the chest wall B. crepitus with palpation of the chest C. clear and equal breath sounds D. unequal expansion of the chest wall

C

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: Select one: A. immediately perform a rapid head-to-toe exam. B. circumferentially tape a dressing around his chest. C. administer oxygen and transport to the hospital. D. recognize that he needs a needle decompression.

C

An open pneumothorax occurs when: Select one: A. air enters the pleural space from outside the body. B. a fractured rib perforates the tissue of the lung. C. extreme pleural pressure causes the lung to rupture. D. air enters the pleural space from a perforated lung.

A

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: Select one: A. pneumothorax. B. myocardial contusion. C. cardiac tamponade. D. flail chest.

A

Paradoxical chest movement is typically seen in patients with: A. a flail chest. B. a pneumothorax. C. isolated rib fractures. D. a ruptured diaphragm.

A

Pleural fluid is contained between the: A. visceral and parietal pleurae. B. parietal pleura and the heart. C. visceral pleura and the lung. D. parietal pleura and the chest wall.

A

Which of the following is NOT a pertinent negative to note during your assessment of a patient with chest trauma? A. No heart murmurs B. No associated shortness of breath C. No rapid breathing D. No areas of deformity

A

Which of the following organs or structures does NOT reside within the mediastinum? A. lungs B. trachea C. vena cavae D. esophagus

A

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: A. commotio cordis B. cardiac tamponade C. pnumonthorax D. traumatic asphyxia

A

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: A. aggressively manage his airway. B. request a paramedic ambulance. C. perform a secondary assessment. D. suspect a severe hemopneumothorax

A

A 40-year-old man, who was the unrestrained driver of a car that hit a tree at a high rate of speed, struck the steering wheel with his chest. He has a large bruise over the sternum and an irregular pulse rate of 120 beats/min. You should be MOST concerned that he: A. has injured his myocardium. B. has a collapsed lung and severe hypoxia. C. has extensive bleeding into the pericardial sac. D. is at extremely high risk for ventricular fibrillation.

A

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: A. rib fractures B. a sternal fracture C. a pneumothorax D. a pulmonary contusion

A

A spinal cord injury at the level of C7 would MOST likely result in: Select one: A. paralysis of the intercostal muscles. B. paralysis of the diaphragm. C. immediate cardiac arrest. D. paralysis of all the respiratory muscles.

A

Patients with chest injuries will often present with _______. Select one: A. tachypnea B. agonal respirations C. Cheyne-Stokes respirations D. Kussmaul respirations

A

A patient experienced a severe compression to the chest when trapped between a vehicle and a brick wall. You suspect traumatic asphyxia due to the hemorrhage into the sclera of his eyes and which other sign? A. Flat neck veins B. Cyanosis in the face and neck C.Asymmetrical chest movement D. Irregular heart rate

B

Which of the following is most likely to cause immediate death? Select one: A. Pulmonary contusion B. Aortic rupture C. Aortic dissection D. Myocardial contusion

B

A 14-year-old baseball player was hit in the chest with a line drive. He is in cardiac arrest. Which of the following is the most likely explanation? A. Myocardial contusion B. Traumatic asphyxia C. Commotio cordis D. Hemothorax

C

On inhalation, which of the following does NOT occur? A. the intercostal muscles contract, elevating the rib cage B. the diaphragm contracts C. the pressure inside the chest increases D. air enters through the nose and mouth

C

The ________ nerves control the diaphragm. A. vagus B. costal C. phrenic D. intercostal

C

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: Select one: A. insert an oropharyngeal airway. B. obtain a set of baseline vital signs. C. immediately request ALS support. D. perform a focused secondary exam.

C

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. A. tension pneumothorax B. hemothorax C. hemopneumothorax D. pneumothorax

D

A flail chest occurs when: Select one: A. more than three ribs are fractured on the same side of the chest. B. a segment of fractured ribs bulges during the inhalation phase. C. multiple ribs are fractured on both sides of the thoracic cage. D. a segment of the chest wall is detached from the thoracic cage.

D

A patient who presents with profound cyanosis following a chest injury: A. should be placed in Trendelenburg's position. B. is most likely experiencing severe blood loss. C. has most likely experienced a ruptured aorta. D. requires prompt ventilation and oxygenation.

D

Children are often "belly breathers" because _______. A. they are consciously controlling ventilations B. they are routinely hypoxic C. their diaphragm is not functional D. their intercostal muscles are not developed

D

Closed chest injuries are typically caused by _______. Select one: A. flying debris B. high-velocity weapons C. penetrating trauma D. blunt trauma

D

During your assessment of a patient who was stabbed, you see an open wound to the left anterior chest. Your MOST immediate action should be to: A. position the patient on the affected side. B. transport immediately. C. assess the patient for a tension pneumothorax. D. cover the wound with an occlusive dressing.

D

Elevation of the rib cage during inhalation occurs when: A. the diaphragm descends. B. abdominal contents descend. C. intrathoracic pressure decreases. D. the intercostal muscles contract.

D

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: Select one: A. often breathes at a slower rate because of lung damage caused by the injury. B. will eliminate more carbon dioxide than if he or she were breathing deeply. C. will maintain adequate minute volume if his or her respiratory rate stays the same. D. must increase his or her respiratory rate to maintain adequate minute volume.

D

The phrenic nerves control the diaphragm and exit the spinal cord at: A. C1 and C2. B. C3 and C4. C. C1, C2, and C3. D. C3, C4, and C5

D

The thoracic cavity is separated from the abdominal cavity by the: Select one: A. intercostal margin. B. costovertebral angle. C. anterior rib cage. D. diaphragm.

D

When a person is lying supine at the end of exhalation, the diaphragm: Select one: A. is less prone to penetrating trauma. B. descends below the level of the navel. C. contracts and flattens inferiorly. D. may rise as high as the nipple line.

D

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: Select one: A. massive hemothorax. B. tension pneumothorax. C. pericardial tamponade. D. laceration of the aorta.

D