CHAPTER 35 CHEST TRAUMA

Which of the following statements regarding a pericardial tamponade is correct?

In a pericardial tamponade, blood collects between the visceral and parietal pericardium.

Which of the following clinical signs may not be present in a patient with a tension pneumothorax and associated internal bleeding?

Jugular vein distention

Which of the following is NOT a mediastinal structure?

Lung

Which of the following thoracic injuries would you LEAST likely discover in the primary assessment?

Myocardial contusion

Following blunt trauma to the anterior chest, a 44-year-old woman presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of her chest. You should:

Perform an immediate needle thoracentesis to the right side of the chest.

A 26-year-old unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. You assessment of her chest reveals a segment of obviously fractured ribs that bulges outward during exhalation. Her breathing is labored and shallow and her oxygen saturation is 80%. You should:

Assist her ventilations with a bag-mask device and 100% oxygen.

You are dispatched to a residence for an injured person. The scene has been secured by law. The patient, a young female, tells you that her boyfriend kicked her in the chest yesterday during an argument. Your assessment reveals that the patient is in significant pain, is dyspneic, has a strong heart rate of 98 beats/min, and has an area of ecchymosis over her left lower rib cage. Auscultation to the left side of her chest reveals coarse crackles. Which of the following treatment interventions is likely NOT indicated for this patient?

IV fluid boluses

Unlike a tension pneumothorax, a massive hemothorax would MOST likely present with:

collapsed jugular veins.

Immediate treatment for an open pneumothorax involves:

converting the pneumothorax to a closed injury.

The eighth, ninth, and tenth ribs are indirectly attached to the sternum by the:

costal cartilage.

The pressure within the right ventricle is:

one fourth of the pressure within the left ventricle.

With the exception of the aorta, great vessel injury is MOST likely to occur following:

penetrating trauma.

A robbery suspect was shot once in the left anterior chest by law enforcement personnel when he pulled a gun on them. The patient is exhibiting obvious signs of shock, is in significant respiratory distress, and is coughing up blood. Further assessment reveals collapsed jugular veins and absent breath sounds over the left hemithorax. After covering the gunshot wound with the appropriate dressing, you should:

provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center.

The anterior-most portion of the heart is the:

right ventricle.

The space between the second and third ribs is called the:

second intercostal space.

Traumatic injuries to the aorta are MOST commonly the result of:

shearing forces.

What is the cardiac output for an 80-kg man who has a heart rate of 80 beats/min and a stroke volume of 60 mL?

4,800 mL

Which of the following statements regarding diaphragmatic injury is correct?

Because the diaphragm is protected by the liver on the right side, most diaphragmatic injuries caused by blunt force trauma occur on the left side.

Which of the following is NOT a sight of potential injury when the aorta is subjected to shearing forces during rapid deceleration?

Coronary sinus

Any normotensive patient with a sternal fracture should receive:

ECG monitoring

You are transporting a conscious and alert woman who experienced an isolated blunt injury to the right anterolateral chest. Her vital signs are stable, but she is dyspneic and her breath sounds are diminished over the apex of her right lung. In addition to administering high-flow oxygen, the MOST critical intervention for this patient involves:

Frequently reassessing her for signs of clinical deterioration.

Which of the following clinical findings would MOST likely differentiate a massive hemothorax from a tension pneumothorax?

Hemoptysis

Common clinical findings associated with a traumatic asphyxia include all of the following, EXCEPT: .

Hyphema

You are dispatched to a residence for an injured person. The scene has been secured by law enforcement. The patient, a young female, tells you that her boyfriend kicked her in the chest yesterday during an argument. Your assessment reveals that the patient is in significant pain, is dyspneic, has a strong pulse rate of 98 beats/min, and has an area of ecchymosis over her left lower rib cage. Auscultation to the left side of her chest reveals coarse crackles. Which of the following treatment interventions is likely NOT indicated for this patient?

IV fluid boluses

Which of the following is an appropriate site for performing a needle thoracentesis?

Superior to the third rib into the intercostal space at the midclavicular line

What type of chest injury is characterized by air accumulation in the pleural space when a perforation in the lung parenchyma acts as a one-way valve?

Tension pneumothorax

Which of the following statements regarding the thorax is correct?

The diaphragm inserts into the anterior thoracic cage below the fifth rib.

In general, patients suspected of having a partial tracheal tear should be managed with:

The least invasive airway techniques possible. .

Ribs four through nine are the most commonly fractured because:

They are less protected by other bony and muscular structures.

Most hemothoraces occur when:

a fractured rib injures the lung parenchyma.

A flail chest is characterized by:

a free-floating segment of fractured ribs.

Bony structures of the thorax include all of the following, EXCEPT the:

acromion.

The visceral pericardial layer:

adheres to the heart and forms the epicardium.

A 50-year-old man was working on his car when the jacks collapsed and the car landed on his chest. Your assessment reveals profound cyanosis and swelling to his chest and face, agonal respirations, and a weak carotid pulse. This patient will benefit MOST from:

aggressive airway management and rapid transport.

Pneumothorax is MOST accurately defined as:

air or gas within the pleural cavity.

A pulmonary contusion following blunt chest trauma results in:

alveolar and capillary damage with intraparenchymal lung hemorrhage.

Most of the heart is protected:

anteriorly by the sternum.

A 26-year-old unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. After performing your primary assessment and administering high-flow oxygen, you assess her chest and note a segment of obviously fractured ribs that bulges outward during exhalation. You should:

apply a bulky dressing to the segment of fractured ribs.

The eleventh and twelfth ribs are known as the floating ribs because they:

are not attached anteriorly to the sternum.

As soon as the aorta exits the left ventricle, it:

ascends toward the right shoulder.

Tracheobronchial injuries have a high mortality due to:

associated airway obstruction.

Any patient with a presumptive diagnosis of a pneumothorax should:

be considered unstable and reassessed every 5 minutes.

Most patients with an aortic injury will complain of pain:

behind the sternum or in the scapula

Common clinical findings associated with a traumatic asphyxia include all of the following, EXCEPT:

hyphema.

The diaphragm:

forms a barrier between the thoracic and abdominal cavities.

You are transporting a conscious and alert man who experienced an isolated blunt injury to the right anterolateral chest. His vital signs are stable, but he is dyspneic and his breath sounds are diminished over the apex of his right lung. In addition to administering high-flow oxygen, the MOST critical intervention for this patient involves:

frequently reassessing him for signs of clinical deterioration.

Due to intrapulmonary hemorrhage, patients with a pulmonary contusion may present with:

hemoptysis

You would NOT expect a patient with a flail chest to present with:

hyperpnea

Commotio cordis is a phenomenon in which:

ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period.

Which of the following clinical findings is MOST suggestive of inadequate oxygenation?

Altered mental status

A 16-year-old boy collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to:

Attach the ECG leads and be prepared to defibrillate.

When performing a needle decompression of the chest, you should insert the needle:

at a 90-degree angle and listen for the release of air.

A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are distended and his breath sounds are bilaterally diminished but equal. The MOST appropriate treatment for this patient involves:

covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route.

Dysrhythmias following a myocardial contusion are usually secondary to:

damage to myocardial tissue at the cellular level.

As air accumulates in the pleural space, the FIRST thing to occur is:

decreased pulmonary function.

You are assessing a 39-year-old man who experienced blunt chest trauma. He is semiconscious and has poor respiratory effort with stridor. You should:

insert a nasal airway and assist ventilations with a bag-mask device

A 30-year-old man felt a snap in his chest when he abruptly twisted his torso. He is conscious and alert, and complains of severe pain during inhalation. Your assessment reveals palpable tenderness over the fifth and sixth ribs on the left side. His vital signs are stable and he denies other injuries. In addition to administering supplemental oxygen, the MOST appropriate treatment for this patient involves:

instructing the patient to hold a pillow against his chest, considering IV analgesics, and transporting to the hospital.

Jugular venous distention during a tension pneumothorax:

is caused by blood accumulation in the vena cava.

Increased intravenous pressure commonly manifests as:

jugular venous distention.

Crackles or rales in the lungs following a myocardial contusion would MOST likely result from:

left ventricular dysfunction

Management of a diaphragmatic injury focuses on:

maintaining adequate oxygenation and ventilation, and rapid transport.

The self-splinting effect observed in patients with chest wall trauma:

may cause atelectasis, hypoxemia, or pneumonia.

By definition, a massive hemothorax is characterized by:

more than 1,500 mL of blood within the pleural space.

An open pneumothorax causes ventilatory inadequacy when:

negative pressure created by inspiration draws air into the pleural space.

You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and:

normal lung sounds.

Following blunt trauma to the anterior chest, a 44-year-old man presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of his chest. You should:

perform an immediate needle thoracentesis to the right side of the chest.

Pneumothoraces create a ventilation-perfusion mismatch when:

perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.

A blood pressure of 100/70 mm Hg in the presence of clinical signs of a tension pneumothorax:

suggests adequate cardiac compensation for the diminished venous return.

The preferred site for performing a needle thoracentesis is:

superior to the third rib into the intercostal space at the midclavicular line.

If the pleural space becomes filled with air or blood:

surface tension is lost and the lung collapses.

In general, patients suspected of having a partial tracheal tear should be managed with:

the least invasive airway techniques possible.

Isolated rib fractures may result in inadequate ventilation because:

the patient often purposely limits chest wall movement.

Ribs 4 through 9 are the most commonly fractured because:

they are less protected by other bony and muscular structures.