EMT Ch 29 Chest Injuries

The correct answer is: 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: Select one: A. determine if he has cardiac problems. B. apply an AED and assess his BP. C. prepare for immediate transport. D. apply bulky dressings to the sternum.

The correct answer is: aggressively manage his airway.

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. perform a secondary assessment. B. suspect a severe hemopneumothorax. C. request a paramedic ambulance. D. aggressively manage his airway.

The correct answer is: air enters the pleural space from outside the body.

An open pneumothorax occurs when: Select one: A. air enters the pleural space from a perforated lung. B. air enters the pleural space from outside the body. C. extreme pleural pressure causes the lung to rupture. D. a fractured rib perforates the tissue of the lung.

The correct answer is: their intercostal muscles are not developed

Children are often "belly breathers" because _______. Select one: A. their intercostal muscles are not developed B. they are routinely hypoxic C. they are consciously controlling ventilations D. their diaphragm is not functional

The correct answer is: blunt trauma

Closed chest injuries are typically caused by _______. Select one: A. penetrating trauma B. flying debris C. high-velocity weapons D. blunt trauma

The correct answer is: assist ventilations with a bag-valve mask.

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. apply high-flow oxygen via nonrebreathing mask. B. request a paramedic to decompress the chest. C. make note of it and continue your assessment. D. assist ventilations with a bag-valve mask.

The correct answer is: the intercostal muscles contract.

Elevation of the rib cage during inhalation occurs when: Select one: A. the diaphragm descends. B. the intercostal muscles contract. C. intrathoracic pressure decreases. D. abdominal contents descend.

The correct answer is: 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: Select one: A. cardiac tamponade. B. myocardial contusion. C. pneumothorax. D. flail chest.

The correct answer is: The pressure inside the chest increases.

On inhalation, which of the following does NOT occur? Select one: A. The pressure inside the chest increases. B. The intercostal muscles contract, elevating the rib cage. C. Air enters through the nose and mouth. D. The diaphragm contracts.

The correct answer is: tachypnea

Patients with chest injuries will often present with _______. Select one: A. tachypnea B. Kussmaul respirations C. Cheyne-Stokes respirations D. agonal respirations

The correct answer is: visceral and parietal pleurae.

Pleural fluid is contained between the: Select one: A. visceral and parietal pleurae. B. visceral pleura and the lung. C. parietal pleura and the heart. D. parietal pleura and the chest wall.

The correct answer is: phrenic

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

The correct answer is: C3, C4, and C5.

The phrenic nerves control the diaphragm and exit the spinal cord at: Select one: A. C1 and C2. B. C3, C4, and C5. C. C3 and C4. D. C1, C2, and C3.

The correct answer is: a segment of the chest wall is detached from the thoracic cage.

A flail chest occurs when: Select one: A. a segment of the chest wall is detached from the thoracic cage. B. multiple ribs are fractured on both sides of the thoracic cage. C. more than three ribs are fractured on the same side of the chest. D. a segment of fractured ribs bulges during the inhalation phase.

The correct answer is: 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: Select one: A. pulmonary contusion. B. traumatic asphyxia. C. tension pneumothorax. D. massive hemothorax.

The correct answer is: requires prompt ventilation and oxygenation.

A patient who presents with profound cyanosis following a chest injury: Select one: A. is most likely experiencing severe blood loss. B. requires prompt ventilation and oxygenation. C. has most likely experienced a ruptured aorta. D. should be placed in Trendelenburg position.

The correct answer is: is commonly caused by blunt chest trauma.

A simple pneumothorax: Select one: A. is commonly caused by blunt chest trauma. B. heals on its own without any treatment. C. often has a nontraumatic cause. D. is caused by penetrating chest trauma.

The correct answer is: paralysis of the intercostal muscles.

A spinal cord injury at the level of C7 would MOST likely result in: Select one: A. paralysis of the diaphragm. B. paralysis of the intercostal muscles. C. paralysis of all the respiratory muscles. D. immediate cardiac arrest.

The correct answer is: 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? Select one: A. Engorged jugular veins B. Widening pulse pressure C. Diminished breath sounds D. A rapid, irregular pulse

The correct answer is: 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: Select one: A. will maintain adequate minute volume if his or her respiratory rate stays the same. 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. often breathes at a slower rate because of lung damage caused by the injury.

The correct answer is: primary assessment

Immediately life-threatening chest injuries must be found and managed during the _______. Select one: A. primary assessment B. patient history C. secondary assessment D. scene size-up

The correct answer is: diaphragm.

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

The correct answer is: may rise as high as the nipple line.

When a person is lying supine at the end of exhalation, the diaphragm: Select one: A. is less prone to penetrating trauma. B. may rise as high as the nipple line. C. descends below the level of the navel. D. contracts and flattens inferiorly.

The correct answer is: Clear and equal breath sounds

Which of the following is NOT a sign or symptom of a chest injury? Select one: A. Clear and equal breath sounds B. Crepitus with palpation of the chest C. Bruising of the chest wall D. Unequal expansion of the chest wall

The correct answer is: Aortic rupture

Which of the following is most likely to cause immediate death? Select one: A. Aortic dissection B. Pulmonary contusion C. Aortic rupture D. Myocardial contusion

The correct answer is: Lungs

Which of the following organs or structures does NOT reside within the mediastinum? Select one: A. Vena cavae B. Esophagus C. Lungs D. Trachea

The correct answer is: administer oxygen and transport to the hospital.

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. circumferentially tape a dressing around his chest. B. administer oxygen and transport to the hospital. C. immediately perform a rapid head-to-toe exam. D. recognize that he needs a needle decompression.

The correct answer is: 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: Select one: A. pericardial tamponade. B. laceration of the aorta. C. massive hemothorax. D. tension pneumothorax.

The correct answer is: 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: Select one: A. call for a paramedic ambulance. B. partially remove the dressing. C. begin rapid transport at once. D. begin ventilatory assistance.

The correct answer is: 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: Select one: A. obtain a set of baseline vital signs. B. perform a focused secondary exam. C. immediately request ALS support. D. insert an oropharyngeal airway.