Chapter 27 Chest Injuries

A flail chest occurs when:

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:

Administer oxygen and transport to the hospital.

Subcutaneous emphysema is an indication that:

Air is escaping into the chest wall from a damaged lung.

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

Hemoptysis is defined as:

Coughing up blood

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

Hematemesis

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.

Definitive care for a tension pneumothorax involves:

Inserting a needle through the rib cage into the pleural space

You arrive on 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 seat belt. 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 the 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 laying supine at the end of exhalation, the diaphragm:

May rise as high as the nipple line.

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

Myocardial contusion.

The___nerves control the diaphragm.

Phrenic

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called?

Pleurisy

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

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:

Prepare for immediate transport

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:

Provide some form of positive pressure ventilation

A patient who presents with profound cyanosis following a chest injury

Requires prompt oxygenation and ventilation

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?

Stabilize the chest wall with a bulky dressing.

Elevation of the rib cage during inhalation occurs when:

The intercostal muscles contract.

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 ?

Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

Pleural fluid is contained between the:

Visceral and parietal pleurae