EMT - Chapter 30: Chest Injuries, Chapter 29 Chest Injuries

The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes what​ statement?

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

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. aggressively manage his airway.

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

A. diaphragm.

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? A. engorged jugular veins B. widening pulse pressure C. diminished breath sounds D. a rapid, irregular pulse

A. engorged jugular veins

A spontaneous pneumothorax would MOST likely occur as the result of: A. exertion of a person with a congenital lung defect. B. excessive coughing in a patient with pneumonitis. C. abnormally slow breathing in a patient with pleurisy. D. blunt or penetrating trauma to the anterior chest wall.

A. exertion of a person with a congenital lung defect.

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

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

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

A. administer oxygen and transport to the hospital.

Patients with rib fractures will commonly: A. breathe rapidly and shallowly. B. take a series of deep breaths. C. prefer to lie in a supine position. D. develop a sucking chest wound.

A. breathe rapidly and shallowly.

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

A. lungs

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called: A. pleurisy. B. dyspnea. C. pneumonitis. D. pneumothorax.

A. pleurisy.

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?

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

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

B. air enters the pleural space from outside the body.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT: A. profound cyanosis. B. collapsed jugular veins. C. bulging intercostal muscles. D. unilaterally absent breath sounds.

B. collapsed jugular veins.

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged: A. minute volume will increase. B. minute volume will decrease. C. minute volume will remain unchanged. D. excess carbon dioxide will be eliminated.

B. minute volume will decrease.

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a: A. ruptured aorta. B. myocardial contusion. C. pericardial tamponade. D. tension pneumothorax.

B. myocardial contusion.

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

B. partially remove the dressing.

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

B. pneumothorax.

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of: A. a tension pneumothorax. B. traumatic aortic rupture. C. penetrating lung injuries. D. a massive cardiac contusion.

B. traumatic aortic rupture.

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. C3, C4, and C5.

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

Reduced tidal volume due to shifting of expiratory air from the uninjured side to the injured side is a common result of which​ injury?

Flail segment

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 lun

Hypoxia

In which thoracic injury is a mechanical collapse of the vena cava​ involved?

Tension pneumothorax

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

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. a. suspect a severe hemopneumothorax. b. perform a secondary assessment. c. aggressively manage his airway. d. request a paramedic ambulance.

aggressively manage his airway

When you are treating a patient who sustained a rib​ fracture, you should administer oxygen if the patient is in respiratory distress​ and:

apply a sling and swathe to the patient.

Closed chest injuries are typically caused by ________?

blunt trauma

Pulmonary contusions are serious injuries because​ they:

can interfere with oxygen exchange.

A simple pneumothorax:

is commonly caused by blunt chest trauma

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

may rise as high as the nipple line

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:

pericardial tamponade.

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

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

primary assessment

During the secondary​ assessment, the EMT notes instability and a flail segment to a​ patient's lower left lateral chest. The EMT would​ immediately:

stabilize the segment with his hand.

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:

start 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:

starts positive pressure ventilation.

Pleural fluid is contained between the: a. visceral pleura and the lung. b. parietal pleura and the chest wall. c. visceral and parietal pleurae. d. parietal pleura and the heart.

visceral and parietal pleurae.

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?

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

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? A. ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle B. asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta C. fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia D. collapse of both lu

A. ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

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:Select one: a. request a paramedic to decompress the chest. b. apply high-flow oxygen via nonrebreathing mask. c. make note of it and continue your assessment. d. assist ventilations with a bag-valve mask.

Assist ventilations with a bag-valve mask

Hemoptysis is defined as: A. vomiting blood. B. coughing up blood. C. abnormal blood clotting. D. blood in the pleural space.

B. coughing up blood.

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

B. may rise as high as the nipple line.

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?

Paradoxical chest wall movement

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. visceral and parietal pleurae.

A flail chest occurs when:

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

Elevation of the rib cage during inhalation occurs when: a. intrathoracic pressure decreases b. the diaphragm descends. c. the intercostal muscles contract. d. abdominal contents descend.

intercostal muscles contract

Patients with chest injuries will often present with _______?

tachypnea

Common signs and symptoms of a chest injury include all of the following, EXCEPT: A. tachypnea. B. hematemesis. C. localized pain. D. chest wall ecchymosis.

B. hematemesis.

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 applying 100% oxygen, you should: A. apply an automated external defibrillator (AED) and take his blood pressure. B. prepare for immediate transport. C. determine if he has cardiac problems. D. apply bulky dressings to the sternum.

B. prepare for immediate transport.

Pneumothorax is defined as: A. accumulation of air between the lungs. B. blood collection within the lung tissue. C. accumulation of air in the pleural space. D. blood collection within the pleural space.

C. accumulation of air in the pleural space.

Subcutaneous emphysema is an indication that: A. at least half of one lung has completely collapsed. B. your patient is experiencing a pericardial tamponade. C. air is escaping into the chest wall from a damaged lung. D. blood is slowly accumulating within the tissue of the lung.

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

You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% 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? A. a total collapse of the affected lung B. hidden bleeding in the thoracic cavity C. compression of the aorta and vena cava D. blood accumulation in the pleural space

C. compression of the aorta and vena cava

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: 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. must increase his or her respiratory rate to maintain adequate minute volume. D. will maintain adequate minute volume if his or her respiratory rate stays the same.

C. must increase his or her respiratory rate to maintain adequate minute volume.

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

C. paralysis of the intercostal muscles.

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

C. phrenic

Very young children tend to breathe predominantly with their diaphragm because: A. their chest wall and ribs are very pliable. B. they require less tidal volume per breath. C. their intercostal muscles are not fully developed. D. there is no nerve innervation of the intercostal muscles.

C. their intercostal muscles are not fully developed.

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: A. insert an oropharyngeal airway.

D. immediately request ALS support.

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:

Look for an exit wound

Which of the following organs or structures does NOT reside within the mediastinum?Select one: a. Trachea b. Venacavae c. Lungs d. Esophagu

Lungs

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?

Monitor breath sounds.

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?

Onset of an irregular heartbeat

Your patient was shot in the right upper chest. Upon inspecting the​ wound, you notice that is bubbles each time the patient exhales. Which injury is MOST​ likely?

Open pneumothorax

Your patient was stabbed in the left anterior chest wall at the midclavicular line and fourth rib. His breath sounds are​ normal, but he is in severe distress and obvious shock. What do you suspect has happened to​ him?

Pericardial tamponade

What mechanism of injury produces the conditions for traumatic​ asphyxia?

Person pinned between a truck and wall of a building

Damage to tissues of what thoracic​ structure(s) will cause impairment of ventilation and a​ pneumothorax?

Pleural membranes

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?

Pulmonary contusion

Which term is used for bleeding that occurs in and around the​ alveoli, reducing oxygen​ exchange?

Pulmonary contusion

You suspect a trauma patient to be suffering from a hemothorax to the left lung. What assessment finding would reinforce this​ suspicion?

Respiratory distress and the signs and symptoms of shock

What occurs when the diaphragm and intercostal muscles​ contract?

The thoracic cage​ enlarges, causing a decrease in intrathoracic and intrapulmonary pressures.

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:

providing positive pressure ventilation.

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

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. stabilize the chest wall with a bulky dressing.

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​ fin

Cardiac contusion

A​ 14-year-old male was struck in the chest by a baseball. On your​ arrival, he is in cardiac arrest. What is the most likely explanation for the sudden cardiac​ arrest?

Commotio cordis

The MOST critical treatment for a tension pneumothorax involves: A. placing a bulky dressing over the affected side of the chest. B. assisting the patient's breathing with increased tidal volume. C. surgically removing the portion of the lung that is damaged. D. inserting a needle through the rib cage into the pleural space.

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

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 unconscious, 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: A. massive hemothorax. B. tension pneumothorax.

D. laceration of the aorta.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should: A. apply 100% oxygen and immediately transport. B. place her supine and elevate her lower extremities. C. perform a rapid head-to-toe physical assessment. D. provide some form of positive-pressure ventilation.

D. provide some form of positive-pressure ventilation.

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. requires prompt ventilation and oxygenation.

When assessing a patient with a hemothorax, you will MOST likely find: A. jugular venous engorgement. B. ipsilateral tracheal deviation. C. distant or muffled heart tones. D. signs and symptoms of shock.

D. signs and symptoms of shock.

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. the intercostal muscles contract.

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?

Decreased breath sounds to the left lung

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?

Reassess for paradoxical motion of the chest wall.

An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs​ when:

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

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

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:

cover the chest wound with a gloved hand.

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

diaphram

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

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

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.

During your physical examination of a patient who was hit in the chest with a baseball​ bat, you notice that a small section of his ribcage sinks when he inhales and moves outward when he exhales. This is known​ as:

paradoxical movement.

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.

The _______________ nerves control the diaphragm.Select one: a. costal b. vagus c. phrenic d. intercostal

phrenic

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

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

requires prompt ventilation and oxygenation.

The​ EMT's primary and first concern with any open injury to the chest​ is:

stopping air entry.

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:

tension pneumothorax.

If a patient has an open chest wound that allowed air to accumulate into the pleural cavity to the point at which the lung is totally collapsed and is starting to shift to the other​ side, this additional complication is known​ as:

tension pneumothorax.

The danger of blood collecting inside the pericardial sac after blunt chest wall trauma is​ that:

the heart cannot contract as effectively.

Children are often "belly breathers" because _________?

their intercostal muscles are not developed