CH 30- Chest Injuries

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

C3, C4, and C5

A flail chest occurs when:

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

Pneumothorax is defined asL

accumulation of air in the pleural space

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

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

You are transporting a stable patient with a possible pneumothorax. The patient is recieving 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

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

hematemesis

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 most suspicious 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 most suggestive 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

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

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 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 patient who presents with profound cyanosis following a chest injury:

requires prompt ventilation and oxygenation

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract

You are caring for an 81-year-old female who fell from a standing position. The patient has pain upon palpation of her right anterior chest and upper abdomen, a pulse of 120, a respiratory rate of 24, and a blood pressure of 86/50. Which of the following is the most likely explanation of the presenting signs?

the patient suffered a rib fracture that has caused a laceration to the liver

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

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 occured?

ventricular fibrillation when the impact occured during a critical portion of the cardiac cycle

Pleural fluid is contained between the:

visceral and parietal pleurae

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

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

Hemoptysis is defined as:

coughing up blood

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

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?

engorged jugular veins

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 ___________ nerves supply the diaphragm

phrenic

A 28-year-old male was struck in the chest with a baseball bate 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

When assessing a patient with a hemothorax, you will most likely find:

signs and symptoms of shock