Chapter 27: Chest Injuries

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 lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest

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 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 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 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. blunt or penetrating trauma to the anterior chest wall D. abnormally slow breathing in a patient with pleurisy

A

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

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

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

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

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

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

The ______ separates the thoracic cavity from the abdominal cavity. A. diaphragm B. mediastinum C. xyphoid process D. inferior border of the ribs

A

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

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

Which of the following statements regarding hemothorax is correct? A. It can only be treated by a surgeon B. It results from a collection of air in the pleural space C. Breath sounds tend to be equal D. It is not typically associated with shock

A

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

You respond to a 20 year old man who was playing basketball and suddenly developed chest pain and respiratory difficulty. He is alert and oriented and complaining of chest pain. He is breathing at 24 breaths/min. His pulse is 140 beats/min and blood pressure is 160/90 mm Hg. Upon listening to the chest, you notice diminished breath sounds on the left side. The patient is most likely suffering from a (n) A. spontaneous pneumothorax B. hemothorax C. tension pneumonthorax D. open pneumonthorax

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. pneumonthorax D. traumatic asphyxia

A

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

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

After experiencing penetrating trauma to the chest, your patient's blood pressure is 110/80 mm Hg. Which of the following repeat blood pressures is MOST indicative of a cardiac tamponade? A. 116/74 mm Hg B. 100/90 mm Hg C. 128/60 mm Hg D. 140/80 mm Hg

B

Air is supplied to the lungs via the: A. esophagus B. trachea C. nares D. oropharnyx

B

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

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

Distended jugular veins, a narrowing pulse pressure, and muffled heart sounds are seen in which of the following conditions? A. Tension pneumothorax B. Cardiac tamponade C. Traumatic asphyxia D. Commotio cordis

B

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

B

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

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

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

Large blood vessels in the chest that can result in massive hemorrhaging include all of the following EXCEPT: A. the pulmonary arteries B. the femoral arteries C. the aorta D. the four main pulmonary veins

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

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

B

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

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

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 for 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 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

When the chest impacts the steering wheel during a motor vehicle crash with rapid deceleration, the resulting injury that kills almost one third of 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: A. begin ventilatory assistance. B. partially remove the dressing. C. begin rapid transport at once. D. call for a paramedic ambulance.

B

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. collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest B. asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta C. ventricular fibrillation when the impact occurred duing a critical portion of the cardiac cycle D. fracture of the sternum that caused a rupture of the myocardium and let to a cardiac dysrhythmia

C

A ______ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms. A. cardiac tamponade B. pulmonary contusion C. myocardial contusion D. traumatic asphyxia

C

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

A sucking chest wound should be treated with: A. a standard dressing B. taping down the chest C. an occlusive dressing D. a sandbag over the wound

C

Common signs and symptoms of tension pneumothorax include all of the following EXCEPT: A. increasing respiratory distress B. distended neck veins C. high blood pressure D. tracheal deviation away from the injured site

C

During your assessment of a patient with a closed chest injury, you should NOT intentionally assess for: A. bruising. B. deformities. C. crepitus. D. breath sounds.

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

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

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

Paradoxical motion of the chest refers to: A. rib fractures that move with the chest wall during breathing B. one segment of the chest wall moving opposite the remainder of the chest C. unequal expansion of the chest wall D. one segment of the chest wall moving out on inspiration and in on exhalation

C

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

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

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

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

C

Traumatic asphyxia: A. is bruising of the lung B. occurs when three or more adjacent ribs fractured in two or more places C. is a sudden, severe compression of the chest D. results from the pericardial sac filling with blood

C

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

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

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

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 pneumonthorax B. hemothorax C. hemopneumonthorax D. pneumonthorax

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

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

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

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

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

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

Which of the following would NOT give you a low pulse oximetry reading? A. Damaged heart B. Decrease in circulating red blood cells from bleeding C. Pulmonary contusion D. Carbon monoxide poisoning

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 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. C. pericardial tamponade. D. laceration of the aorta.

D

You respond to a motor vehicle collision and find a 29 year old woman who is complaining of chest pain. Her chest struck the steering wheel. Her airway is open, she is breathing at 24 breaths/min, and she is coughing up blood. Her pulse is 130 beats/min, rapid and weak, her blood pressure is 90/58 mm Hg. You notice cyanosis around the lips and note that her fingers are also blue. When you expose the chest, she tells you it hurts and points to a bruised spot. Which of the following is a symptom? A. Cyanosis around the lips or fingertips B. Rapid, weak pulse C. Hemoptysis D. Pain at the site of injury

D

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. B. obtain a set of baseline vital signs. C. perform a focused secondary exam. D. immediately request ALS support.

D

You respond to the local rodeo arena for a bull rider. The scene is safe, and the patient is lying in the middle of the arena unconscious. His airway is open, and he is breathing at 20 breaths/min. His pulse is 128 beats/min and blood pressure is 110/64 mm Hg. There is no obvious bleeding. Bystanders tell you he was thrown into the air and landed on the bull's head. He was not wearing a vest. Which of the following is NOT indicated in blunt trauma to the chest? A. Bruising of the lungs and heart B. Fracture of whole areas of the chest wall C. Damage to the aorta D. Dissection of the carotid arteries

D