Chapter 29 Chest Injuries Q&A
Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle
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?
prepare for immediate transport
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:
Commotio cordis
A blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a person's heartbeat.
Myocardial contustion
A bruise of the heart muscle.
Hemothorax
A collection of blood in the pleural cavity.
Flail chest
A condition in which two or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage.
Occlusive dressing
A dressing made of vaseline-impregnated gauze, aluminum foil, or plastic that protects a wound from air and bacteria.
pulmonary contusion
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:
Flutter valve
A one-way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve.
repeats BP of 92/68 mmHg
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?
engorged jugular veins
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?
provide ventilation assistance with a BVM
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:
laceration of the aorta
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:
partially remove the dressing
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:
immediately request ALS support.
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:
ventilation
the body's ability to move air in and out of the lungs is called
Large blood vessels in the chest that can result in massive hemorrhaging include all of the following EXCEPT: - the pulmonary arteries - the femoral arteries - the aorta - the four main pulmonary veins
The femoral arteries
penetrate the lung and diaphragm and injure the liver or stomach
a penetrating chest injury has the potential to
Early bruising following abdominal trauma often manifests as: Select one: A. dark-purple marks. B. red areas of skin. C. localized pain. D. gross distention.
B
myocardial contusion
a rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a
A flail chest occurs when:
a segment of the chest wall is detached from the thoracic cage.
is commonly caused by blunt chest trauma.
a simple pneumothorax
paralysis of the intercoastal muscles
a spinal cord injury at the level of C7 would MOST likely result in:
open injuries
are the result of an object penetrating the skin and/or chest wall
mediastinum
the esophagus, trachea, and great vessels of the body are located in the
Which of the following is NOT a s/s of a chest injury? - Bruising of the chest wall - Crepitus with palpation of the chest - Clear and equal breath sounds - Unequal expansion of the chest wall
- Clear and equal breath sounds
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. pulmonary contusion. B. massive hemothorax. C. traumatic asphyxia. D. tension pneumothorax.
A
Abdominal pain, vomiting, and fever are most likely due to _______. Select one: A. infection B. hemorrhage C. evisceration D. hypovolemia
A
Assuming that no obvious signs of intra-abdominal injury are present, which of the following injuries would MOST likely cause an injury to the liver or spleen to be overlooked? Select one: A. Shoulder fracture B. Pelvic fracture C. Lumbar spine fracture D. Femur fracture
A
Because solid organs have a rich supply of blood, any injury can result in major: A. hemorrhaging B. damage C. pain D. guarding
A
Patients with chest injuries will often present with _______. Select one: A. tachypnea B. agonal respirations C. Kussmaul respirations D. Cheyne-Stokes respirations
A
Patients with open abdominal injures often complain of: A. pain B. nausea C. vomiting D. dyspnea
A
Suspect a possible injury of the urinary bladder in all of the following findings EXCEPT: A. bruising to the left upper quadrant B. blood at the urethral opening C. blood at the tip of the penis or a stain on the patient's underwear D. physical signs of trauma on the lower abdomen, pelvis or perineum
A
The largest organ in the abdomen is the: A. liver B. spleen C. pancreas D. kidneys
A
The major complaint of patients with abdominal injury is: A. pain B. tachycardia C. rigidity D. swelling
A
The mesentery is: Select one: A. a membranous fold that attaches the intestines to the walls of the body. B. a complex network of blood vessels that supply blood to the liver. C. the point of attachment between the small and large intestines. D. a layer of thick skeletal muscles that protects the abdominal organs.
A
The phrenic nerves control the diaphragm and exit the spinal cord at: Select one: A. C3, C4, and C5. B. C3 and C4. C. C1 and C2. D. C1, C2, and C3.
A
The solid organs of the urinary system include the: A. kidneys B. ureters C. bladder D. urethra
A
The thoracic cavity is separated from the abdominal cavity by the: Select one: A. diaphragm. B. intercostal margin. C. costovertebral angle. D. anterior rib cage.
A
Which of the following is true regarding injury to the kidneys? Select one: A. Injury to the kidneys usually indicates injury to other organs. B. Only minimal force is needed to damage the kidneys. C. The kidneys are not well protected. D. Kidney injuries are rarely caused by blunt trauma.
A
While assessing a 21 year old female who struck a tree head-on with her small passenger car, you not that her air bag deployed. You should: A. life the air bag and look for deformity to the steering wheel. B. carefully assess her upper chest for seat belt-related injuries C. perform a head-to-toe assessment while she is in the car D. extricate her immediately and transport to a trauma center
A
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. laceration of the aorta. B. massive hemothorax. C. pericardial tamponade. D. tension pneumothorax.
A
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. immediately request ALS support. B. obtain a set of baseline vital signs. C. insert an oropharyngeal airway. D. perform a focused secondary exam.
A
Spontaneous pneumothorax
A pneumothorax that occurs when a weak area on the lung ruptures in the absent of major injury, allowing air to leak into the pleural space.
An open pneumothorax occurs when:
Air enters the pleural space from outside the body.
Tension pneumothorax
An accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.
Pneumothorax
An accumulation of air or gas in the pleural cavity.
A sucking chest wound should be treated with:
An occlusive dressing
Sucking chest wound
An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound.
Open pneumothorax
An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound.
Simple pneumothorax
Any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient.
A 20 year old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assesment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superifical. You should: A. carefully probe the wound to determine its depth B. assume that the arrow injured an internal organ C. clean the wound and apply a dry, sterile dressing D. transport only if signs of shock begin to develop.
B
A 66 year old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert, however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him? A. Do you take any over-the-counter medications? B. Have you experienced recent abdominal trauma? C. Has blood soaked through your undergarments? D. What does your blood pressure normally run?
B
A flail chest occurs when: Select one: A. a segment of fractured ribs bulges during the inhalation phase. B. a segment of the chest wall is detached from the thoracic cage. C. multiple ribs are fractured on both sides of the thoracic cage. D. more than three ribs are fractured on the same side of the chest.
B
Air in the abdominal cavity can cause all of the following EXCEPT: A. pain B. diarrhea C. infection D. tissue ischemia and infarction
B
Because the depth of an open abdominal wound is often difficult to determine: Select one: A. the abdomen must be vigorously palpated. B. prompt transport to the hospital is essential. C. vital signs should be monitored frequently. D. the EMT must perform a thorough exam.
B
Blunt abdominal injuries may result from: A. a stab wound B. seat belts C. a gunshot wound D. an impaled object
B
Children are often "belly breathers" because _______. Select one: A. they are routinely hypoxic B. their intercostal muscles are not developed C. they are consciously controlling ventilations D. their diaphragm is not functional
B
Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. air bag deployment B. a poorly placed lap belt C. failure to wear seat belts D. rapid vehicle deceleration
B
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. assist ventilations with a bag-valve mask. C. apply high-flow oxygen via nonrebreathing mask. D. make note of it and continue your assessment.
B
Following blunt abdominal trauma, a 30 year old male complains of referred pain to the left shoulder. This finding is called the: A. Grey Turner sign B. Kehr sign C. Brudzinski sign D. Cullen sign
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
In any case of trauma to a female patient, you should always determine if the patient: A. is on birth control B. is pregnant C. is currently menstruating D. has a history of ovarian cysts
B
In cases of sexual assault, which of the following is true? A. You should always examine the genitalia for any sign of injury B. Advise the patient not to wash, urinate or defecate C. In addition to recording the facts, it is important to include your personal thoughts D. You should use plastic bags when collecting items such as clothes
B
Late signs of peritonitis may include: A. soft abdomen B. nausea C. normal bowel sounds D. diarrhea
B
Peritonitis usually occurs when: Select one: A. bacteria or viruses invade the walls of the gastrointestinal tract. B. hollow abdominal organs are damaged and spill their contents into the peritoneal cavity. C. solid abdominal organs bleed secondary to penetrating trauma. D. the vessels that supply the abdominal organs become inflamed.
B
Pleural fluid is contained between the: Select one: A. parietal pleura and the chest wall. B. visceral and parietal pleurae. C. parietal pleura and the heart. D. visceral pleura and the lung.
B
The ________ nerves control the diaphragm. Select one: A. vagus B. phrenic C. costal D. intercostal
B
The most common sign of significant abdominal injury is: A. pain B. tachycardia C. rigidity D. distention
B
When a person is lying supine at the end of exhalation, the diaphragm: Select one: A. contracts and flattens inferiorly. B. may rise as high as the nipple line. C. descends below the level of the navel. D. is less prone to penetrating trauma.
B
When treating a patient with an amputation of the penile shaft, your top priority is: A. locating the amputated part B. controlling bleeding C. keeping the remaining tissue dry D. delaying transport until bleeding is controlled
B
When worn properly, a seatbelt should lie: Select one: A. above the anterior posterior iliac spines of the pelvis and below the hip joints. B. below the anterior superior iliac spines of the pelvis and against the hip joints. C. across the abdominal wall at the level of the diaphragm and below the hip joints. D. across the abdominal wall at the level of the umbilicus and against the hip joints.
B
Which of the following is NOT a hollow organ of the abdomen? A. Stomach B. Liver C. Bladder D. Urters
B
Which of the following is most likely to cause immediate death? Select one: A. Aortic dissection B. Aortic rupture C. Pulmonary contusion D. Myocardial contusion
B
Which of the following organs or structures does NOT reside within the mediastinum? Select one: A. Esophagus B. Lungs C. Vena cavae D. Trachea
B
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. administer oxygen and transport to the hospital. C. recognize that he needs a needle decompression. D. circumferentially tape a dressing around his chest.
B
You respond to an 18 year old high school football player who was hit in the right flank with a helmet several hours ago. He is complaining of pain in the area. He is alert and oriented. His airway is open and his respirations are within normal limits. His pulse is regular. He has a radial pulse. He tells you that he is noticing blood in his urine. Based on this information, the patient is likely to have an injury to the: A. liver B. kidney C. gallbladder D. appendix
B
Your presence is requested by law enforcement to assess a 33 year old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should: A. arrange for a rape crisis center representative to speak with the patient. B. control any external bleeding, administer oxygen, and transport at once. C. visualize the vaginal area and pack the vagina with sterile dressings D. allow her to change her clothes and take a shower before you transport
B
Your primary concern when dealing with an unresponsive patient with an open abdominal injury is: A. covering the wound with a moist dressing B. maintaining the airway C. controlling the bleeding D. monitoring vital signs
B
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
Clear and equal breath sounds.
blunt trauma
Closed chest injuries are typically caused by _______.
Patients with rib fractures will commonly:
Breathe rapidly and shallowly.
All of the following male genitalia lie outside the pelvis cavity EXCEPT the: A. urethra B. penis C. seminal vesicles D. testes
C
Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the: Select one: A. spleen. B. kidney. C. liver. D. stomach.
C
Elevation of the rib cage during inhalation occurs when: Select one: A. intrathoracic pressure decreases. B. the diaphragm descends. C. the intercostal muscles contract. D. abdominal contents descend.
C
Open abdominal injuries are also known as: A. blunt injuries B. eviscerations C. penetrating injuries D. peritoneal injuries
C
Signs of injury to the kidney may include any of the following EXCEPT: A. bruises or lacerations on the overlying skin B. shock C. increased urgency of urination D. hematuria
C
The presence of tachycardia following a significant abdominal injury: A. indicates a state of decompensated shock B. should be assumed to be a sign of shock C. is most commonly caused by severe pain D. is always accompanied by hypo tension
C
When treating a patient with an evisceration, you should: A. attempt to replace the abdominal contents B. cover the protruding organs with a dry, sterile dressing C. cover the protruding contents with moist, sterile gauze compresses
C
_____ takes place in the solid organs. A. digestion B. Excretion C. Energy production D. Absorption
C
The phrenic nerves control the diaphragm and exit the spinal cord at:
C3, C4, and C5.
Which of the following would NOT give you a low pulse oximetry reading? - Damaged heart - Decrease in circulation red blood cells from bleeding - Pulmonary contusion - Carbon monoxide poising
Carbon monoxide poising
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
Carbon monoxide poisoning.
Distended jugular veins, a narrowing pulse pressure, and muffled heart sounds are seen in which of the following conditions?
Cardiac Tamponade
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
Cardiac tamponade.
Mediastinum
Center cavity of thorax
Thoracic Cage
Chest
Exhalation
Chest falls
Inhalation
Chest rises
their intercostal muscles are not developed
Children are often "belly breathers" because _______.
The thoracic cavity is separated from the abdominal cavity by the:
Diaphragm.
Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT: A. bulging intercostal muscles B. collapsed jugular veins C. unilaterally absent breath sounds D. profound cyanosis
Collapsed jugular veins.
hematemesis
Common signs and symptoms of a chest injury include all of the following, EXCEPT:
You respond to an 18 y/o 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:
Commotio Cordis
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:
Commotio cordis.
Cardiac tamponade (pericardial tamponade)
Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.
Hemoptysis
Coughing up blood
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. apply bulky dressings to the sternum. C. apply an AED and assess his BP. D. prepare for immediate transport.
D
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: Select one: A. suspect a severe hemopneumothorax. B. request a paramedic ambulance. C. perform a secondary assessment. D. aggressively manage his airway.
D
A simple pneumothorax: Select one: A. often has a nontraumatic cause. B. is caused by penetrating chest trauma. C. heals on its own without any treatment. D. is commonly caused by blunt chest trauma.
D
A spinal cord injury at the level of C7 would MOST likely result in: Select one: A. paralysis of the diaphragm. B. paralysis of all the respiratory muscles. C. immediate cardiac arrest. D. paralysis of the intercostal muscles.
D
Accumulation of blood in the abdominal cavity will MOST likely cause: Select one: A. referred pain. B. nausea or vomiting. C. diffuse bruising. D. distention.
D
All of the following systems contain organs that make up the contents of the abominal cavity EXCEPT: A. the digestive system B. the urinary system C. the genitourinary system D. the limbic system
D
An open pneumothorax occurs when: Select one: A. air enters the pleural space from a perforated lung. B. extreme pleural pressure causes the lung to rupture. C. a fractured rib perforates the tissue of the lung. D. air enters the pleural space from outside the body.
D
Closed chest injuries are typically caused by _______. Select one: A. high-velocity weapons B. penetrating trauma C. flying debris D. blunt trauma
D
Contraction or tensing of the abdominal muscles in an effort to ease pain is called: Select one: A. referring. B. flexing. C. withdrawing. D. guarding.
D
Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: Select one: A. stomach. B. aorta. C. spleen. D. diaphragm.
D
During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: Select one: A. a ruptured spleen. B. rupture of a hollow organ. C. a severe liver laceration. D. intra-abdominal bleeding.
D
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. Diminished breath sounds B. A rapid, irregular pulse C. Widening pulse pressure D. Engorged jugular veins
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 maintain adequate minute volume if his or her respiratory rate stays the same. C. will eliminate more carbon dioxide than if he or she were breathing deeply. D. must increase his or her respiratory rate to maintain adequate minute volume.
D
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. cardiac tamponade. B. myocardial contusion. C. flail chest. D. pneumothorax.
D
In pediatric patients, the liver and spleen are _______. Select one: A. more protected by the thorax compared to adults B. smaller in proportion to the abdomen C. less likely to bleed when injured D. larger in proportion to the abdomen
D
Injuries to the external male genitalia _______. Select one: A. usually result in permanent damage B. are often life-threatening C. frequently lead to hypovolemic shock D. are rarely life-threatening
D
Suspect kidney damage if the patient has a history or physical evidence of all of the following EXCEPT: A. an abrasion, laceration, or contusion in the flank B. a penetrating wound in the lower rib cage or the upper abdomen C. fractures on either side of the lower rib cage D. a hematoma in the umbilical region
D
The first signs of peritonitis include all of the following EXCEPT: A. severe abdominal pain B. tenderness C. muscular spasm D. nausea
D
When a patient stiffens the muscles of the abdomen, it is known as _______. Select one: A. crepitus. B. distention. C. instability. D. guarding.
D
When performing a history on a patient with abdominal trauma, which of the following questions would be appropriate regarding trauma? A. Is there any blood in your stool? B. Does your pain go anywhere? C. Do you have any nausea, vomiting or diarrhea? D. All of the above
D
Which of the following statements regarding abdominal evisceration's is correct? A. Adherent material is preferred when covering an evisceration. B. The organs should be replaced carefully to avoid heat loss. C. Most evisceration's occur to the left upper quadrant D. The protruding organs should be kept warm and moist.
D
You are called to the local bar where a fight has taken place. The police department tells you that you have a 36 year old man who has been stabbed twice in the abdomen. Upon your arrival, the patient is alert and oriented. His airway is open. His respirations are at 24 breaths/min, pulse is rapid, regular and weak. He has distal pulses. With the penetrating trauma, you should assume that the object: A. has penetrated the peritoneum B. has entered the abdominal cavity C. has possibly injured one or more organs D. all of the above
D
You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if: A. the severity of the injury is known. B. the patient is conscious. C. there are other patients involved. D. law enforcement is at the scene.
D
You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should: Select one: A. perform a comprehensive secondary assessment to determine why his clinical status has changed. B. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. C. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. D. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.
D
You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately, you should: Select one: A. begin documenting the call on the patient care form. B. perform a comprehensive secondary assessment. C. forgo the hospital radio report because of his condition. D. closely monitor him and reassess him frequently.
D
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 rapid transport at once. B. call for a paramedic ambulance. C. begin ventilatory assistance. D. partially remove the dressing.
D
Your documentation on a sexual assault victim should _______. Select one: A. include your opinion of the nature of the incident B. describe the status of the suspect(s) C. be subjective and summarize the crime D. be objective and factual
D
The _______ separates the thoracic cavity from the abdominal cavity.
Diaphragm
The ________ separates the thoracic cavity from the abdominal cavity.
Diaphragm.
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 beats/min. His pulse is 128 beats/min and bp is 110/64mmHg. 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? - Bruising of the lungs and heart - Fracture of whole areas of the chest wall - Damage of the aorta - Dissection of the carotid arteries
Dissection of the carotid arteries
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
Dissection of the carotid arteries.
Beck's triad
Distended jugular veins, narrowing pulse pressure, and muffled heart tones are collectively known as _______.
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. diminished breath sounds B. engorged jugular veins C. a rapid, irregular pulse D. widening pulse pressure
Engorged jugular veins.
A spontaneous pneumothorax would MOST likely occur as the result of:
Exertion of a person with a congenital lung defect.
T/F: A flutter valve is a three way valve that allows air to leave the chest cavity. #946
F
T/F: Bc pts w/chest injury have so many risks of mortality, they should be reassessed every 10 mins. #943
F
T/F: It is considered acceptable to remain on scene w/a seriously injured pt to facilitate splining of an extremity fracture. #944
F
T/F: Laceration of the large blood vessel in the chest can cause minimal hemorrhage. #952
F
T/F: Narrowing pulse pressure is relate to spontaneous pneumothorax #948
F
T/F: Rib fractures are especially common in children. #949
F
T/F: Tachypnea is slow respirations #940
F
T/F: The right lung contains two lobes, and the left contains three lobes. #936
F
T/F: The thoracic cage extends from the lower end of the neck to the umbilicus #935
F
Common s/s of tension pneumothorax include all of the following EXCEPT: - Increasing respiratory distress - Distended neck veins - High BP - tracheal deviation away from the injured site
High BP
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
High blood pressure.
must increase his or her respiratory rate to maintain adequate minute volume
If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:
traumatic aortic rupture
Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:
primary assessment
Immediately life-threatening chest injuries must be found and managed during the _______.
pneumothorax
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:
Pulmonary contusion
Injury or bruising of lung tissue that results in hemorrhage.
Traumatic asphyxia
Is a sudden, severe compression of the chest.
Traumatic asphyxia:
Is a sudden, severe compression of the chest.
Which of the following statements regarding hemothorax is correct?
It can only be treated by a surgeon
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
It can only be treated by a surgeon.
Aorta
Major artery in the chest
sponatenous pneumothorax
May be the result of rupture of a weak spot on the lung, allowing air to enter the pleural space and accumalate. this often results from nontraumatic injuries and may occur during times of physical activity such as excerise
A _____ is the result of blunt chest trauma and is associated w/an irregular pulse and sometimes dangerous cardiac rhythms.
Myocardial contusion
A __________ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms.
Myocardial contusion.
Which of the following is NOT a pertinent negative to note during your assessment of a pt w/chest trauma?
No heart murmurs
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
No heart murmurs.
You respond to a 20 y/o man who was playing bball 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 BP is 160/90 mm Hg. Upon listening to the chest, you notice diminished breath sounds on the left. This pt is most likely suffering from an:
Open pneumothorax
You respond to a MVC and find a 29 y/o 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, and her BP is 90/58mmHg. You notice cyanosis around the lips and note that her fingers are also blue. When you expose the chest, she tell you it hurts and points to a bruised spot. Which of the following is a symptom?
Pain at the site of injury
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, and 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
Pain at the site of injury.
flail chest
Paradoxical motion is a sign of a _______.
A spinal cord injury at the level of C7 would MOST likely result in:
Paralysis of the intercostal muscles.
tachypnea
Patients with chest injuries will often present with _______.
Open chest injury
Penetrating wound
A ______ results when an injury allows air to enter through a hole in the chest wall or the surface of the lung as the pat attempts to breathe, causing the lung on that side to collapse.
Pneumothorax
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.
Pneumothorax.
A pt w/blunt trauma who is holding the lateral side of his chest and breathing rapid and shallow is most likely suffering from
Rib fractures
A patient with a blunt trauma who is holding the lateral side of his chest and has rapid and shallow respirations is most likely suffering from:
Rib fractures.
Pericadium
Sac around the heart
Diaphragm
Separates chest from abdomen
collapsed jugular veins
Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:
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):
Spontaneous Pneumothorax.
T/F: A rapid, weak pulse and low pressure are the principle signs of hypovolemic shock #940
T
T/F: Distended neck veins may be a sign of a tension pneumothorax
T
T/F: Dyspnea is difficulty breathing
T
T/F: Open chest injury is cause by penetrating trauma
T
T/F: Pts w/ spinal cord injuries at C3 or above can lose their ability to breathe #937
T
T/F: You should control external bleeding w/direct pressure and a bulky dressing
T
Hemopneumothorax
The accumulation of blood and air in the pleural space of the chest.
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
The femoral arteries.
Pericardium
The fibrous sac that surrounds the heart.
Paradoxical motion
The motion of the portion of the chest wall that is detached in a flail chest; the motion--in during inhalation, out during exhalation--is exactly the opposite of normal chest wall motion during breathing.
On inhalation, which of the following does NOT occur? - The inter costal muscles contract, elevating the rib cage - The diaphragm contracts - The pressure inside the chest increases - Air enters through the nose and mouth
The pressure inside the chest increases
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
The pressure inside the chest increases.
diaphragm
The thoracic cavity is separated from the abdominal cavity by the:
Very young children tend to breathe predominantly with their diaphragm because:
Their intercostal muscles are not fully developed.
Air is supplied to the lungs via the:
Trachea
Paradoxical motion of the chest refers to:
Unequal expansion of the chest wall
Closed chest injury
Usually blunt trauma
may rise as high as the nipple line.
When a person is lying supine at the end of exhalation, the diaphragm:
aortic rupture
Which of the following is most likely to cause immediate death?
administer oxygen and transport to the hospita
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:
compression of the aorta and vena cava
You are transporting a stable patient with a possible pneumothorax. The patient is receiving 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?
a segment of the chest wall is detached from the thoracic cage
a flail chest occurs when:
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
high-flow oxygen or ventilation with BVM
all patients with chest injuries should recieve
air enters the pleural space from outside the body
an open pneumothorax occurs when:
pneumothorax Occusive dressing
any penetrating injury to the chest may result in air entering the pleural space and may cause what type of dressing should be used
open or closed
chest injuries are classifed as
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 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?
compression of the aorta and vena cava
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
Common signs and symptoms of a chest injury include all of the following, EXCEPT:
hematemesis.
lungs
hemoptysis indicates damage to the
minute volume will decrease
if a person's tidal volume decreases, but his or her respiratory rate remains unchanged
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 MOST critical treatment for a tension pneumothorax involves:
inserting a needle through the rib cage into the pleural space.
pleurisy
irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:
hemothorax
is the result of blood accumulating in the plueral space after a traumatic injury when the vessels of the lung are lacerated and leak blood
simple pneumothorax
is the result of blunt trauma, such as fractured ribs
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
laceration of the aorta
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.
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
may 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.
life-threatening hemorrage
must be addressed immediately during the primary assessment even before airway or breathing concerns
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.
A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:
myocardial contusion.
commotio cordis
occurs from direct blows to the chest during a critical portion of the patient's heartbeat. it may result in immediate cardiac arrest
closed injuries
often the result of blunt force trauma
breathe rapidly and shallowly
patients with rib fractures will commonly
The ________ nerves control the diaphragm.
phrenic
Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called
pleurisy.
accumulation of air in the pleural space
pneumothorax is defined as:
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:
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
Tachypnea
rapid respirations
A patient who presents with profound cyanosis following a chest injury:
requires prompt ventilation and oxygenation.
When assessing a patient with a hemothorax, you will MOST likely find:
signs and symptoms of shock.
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.
Elevation of the rib cage during inhalation occurs when:
the intercostal muscles contract.
increases the risk of internal injury
the pliability of the pediatric rib cage
inserting a needle through the rib cage into the pleural space
the treatment for relieving a tension pneumothorax involves
myocardial contusion -bruising of the heart muscle after traumatic injury
this condition may have the same signs and symptons as a heart attack, including an irregular pulse, this injuryis an injury to the heart muscle from trauma not from a heart attack
flail chest segment postive-pressure ventilation
three or more ribs broken in two or more places what ventilation may be particularly important for a patient with a flail chest that compromises ventilation
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 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.
pulmonary contusion-bruising of or injury to lung tissue after traumatic injury
what may interfere with oxygen exchange in the lung tissue
open pneumothorax
when a penetrating injury creates a hole in the chest wall, you may hear a sucking sound as the patient inhales this is called
signs and symptons of shock
when assessing a patinet with a hemothorax, you will MOST likely find
cardiac tamponade
when blood collects in the space between the pericardial sac and the heart. this condition results in pressure building up inside the pericardial sac until the heart cannot pump effectively; cardiac arrest may occur quickly
