Chapter 34: Chest Trauma

The AEMT showed that he understands the difference between a pneumothorax and a tension pneumothorax when he made which one of the following statements?

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

Which one of the following statements made by an AEMT shows an understanding of chest trauma?

"Closed chest injuries are caused by blunt trauma, and can be just as serious as open chest injuries."

An adult female is found unresponsive after being shot in the chest. Which one of the following AEMT statements about this patient is of MOST concern?

"She is getting more difficult to ventilate."

Which of the following mechanisms of injury would MOST likely cause a deceleration injury resulting in a pulmonary contusion?

A patient's thorax strikes a steering wheel.

When assessing a patient who sustained blunt trauma to the chest, which one of the following assessment findings is MOST indicative of an injury to the lung?

Ability to speak a few words and then gasp

Q34- A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary assessment, which one of the following sings and symptoms would indicate that she is suffering from a tension pneumothorax?

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

A construction foreman has been stabbed in the right anterior chest with a screwdriver by an angry worker. He is conscious and oriented and complaining of pain to the injury site. Prior to your arrival, he removed the screwdriver. Your primary assessment reveals a patent airway, adequate breathing, and strong radial pulse. Based on these findings, you should:

Administer oxygen through a nonrebreather mask.

On scene a paramedic directs you to help another EMS crew with a patient who was hit by a passenger van that ran into a crowd. As you approach the patient, which one of the following scene size-up clues seemingly indicates the patient is suffering from traumatic asphyxia?

Bluish discoloration to the neck and face.

________ is a major cause of death in traumatic injuries.

Blunt thoracic trauma

Q34-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 breath. 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 findings, the EMT should be suspicous for what condition?

Cardiac contusion.

Which of the following BEST describes the effects of a pericardial tamponade on cardiac output and venous pressure?

Cardiac output is low, and central venous pressure rises.

You are on the scene of a shooting. Your assessment reveals a 23-year-old man 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 makes a sucking sound every time the patient takes a breath. The initial action of the AEMT should be which one of the following?

Cover the chest wound with a gloved hand.

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, which finding should the AEMT consider MOST serious and warrant immediate attention?

Decreased breath sounds to the left lung

Q34-When assessing a patient, which one of the following signs or symptoms is most indicative of the patient suffering from pneumothorax?

Decreased breath sounds to the right lung.

When a patient suffers penetrating trauma to the chest, as the diaphragm moves downward, air will:

Enter the pleural cavity from outside

When auscultating the lungs of a trauma victim, you are listening for:

Equal, bilateral breath sounds

A partial or complete tear of one of the great vessels such as the aorta or vena cava may result in:

Hypovolemia.

You are managing a patient with a large flail segment to the right lateral chest. As such, you should recognize that the immediate threat to life is:

Hypoxia.

Which of the following MOST accurately depicts the chest wall movement in a patient with flail segment?

Inward with inspiration and outward with expiration

Why is an occlusive dressing, taped on three sides, used in a patient with an open pneumothorax?

It converts an open pneumothorax into a simple pneumothorax, reducing the aspiration of air and relieving pressure build-up.

Beck's triad is often found in a pericardial tamponade. Which three of the following findings does it include?

JVC, Hypotension, Muffled heart sounds

A patient has been shot in the chest with a rifle. Your assessment reveals a decreasing level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and you have covered the entrance wound located midclavicular at the second intercostal space on the left side of the chest. Which one of the following should you do next?

Look for an exit wound.

Q34-A 39 year old male has been stabbed once in the anterior chest. When notifying the emergency department of the patient's arrival, you inform them that the patient has suffered what type of injury?

Open chest injury.

Your patient was involved in a serious motor-vehicle collision. Which one of the following assessment findings BEST helps to determine that the patient has a flail segment?

Paradoxical chest wall movement

A condition in which blood accumulates in the sac surrounding the heart is called:

Pericardial tamponade

Which of the following is the MOST appropriate prehospital management for a patient with flail segment?

Positive pressure ventilation

As you are treating a patient who has had blunt trauma to the chest, during transport, oxygen saturation is falling and the patient is experiencing hemoptysis. Lung sounds are clear and equal bilaterally, but diminished due to painful breathing. You suspect:

Pulmonary contusion

You are treating the victim of a shooting who has an open chest wound that has been covered by an occlusive dressing. You notice the patient is now anxious, short of breath, and tachycardic. Your next action should be:

Remove the occlusive dressing.

The presence of a potential myocardial contusion should be based on:

Significant blunt chest trauma.

A patient with a history of COPD experiences a sudden onset of sharp chest pain. Your exam reveals an anxious patient who is breathing rapidly, and has diminished breath sounds to the left lower lobe of the lung and midline trachea. The patient has MOST likely experienced a:

Simple pnuemothorax

As you are performing a rapid trauma exam of the chest, you note the presence of a crackling, rice-crispy-like sensation beneath the skin under the clavicles. This is MOST likely:

Subcutaneous emphysema.

42-year-old man was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and he is complaining of shortness of breath. When he speaks he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which one of the following should you do FIRST?

Suction the blood from the airway.

Air accumulation in the thorax that causes displacement of the mediastinum will result in a condition known as:

Tension pnuemothorax

Which of the following BEST explains why positive pressure ventilation is the correct management step for a patient with flail segment?

The positive pressure displaces the thorax outward, reducing the movement of the fracture site and moving the flail segment with the chest.

Which of the following statements about tension pnuemothorax is FALSE?

Tracheal deviation is the most prevalent and common sign of tension pnuemothorax.

A flail segment occurs when:

Two or more ribs are broken in two or more places.

A paramedic has asked that you apply a dressing over a sucking chest wound to the left anterior chest. Which one of the following should you use to cover the injury?

Vaseline gauze

The MOST important aspect of care when treating a suspected thoracic injury is:

Ventilation and oxygenation

Which of the following statements about flail segments is FALSE?

Ventilation is sufficient if only two ribs are involved in the flail segment

Q34-You have applied a nonporous dressing to a stab wound on a patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides. Your best response is that taping the dressing on three sides:

allows trapped air to escape on exhalation.

Q34-Care for an open chest wound and an abdominal evisceration are similar in that:

occlusion dressings are placed over both wounds.

Q34-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 inadequately at 24 breaths per minute. The EMT shows that he is appropriately caring for this injury when he:

secures a rolled towel over the fractured ribs.