EMT Orange Book - Ch 27

Cushing's Triad

bradycardia widening pulse irregular respirations

Distended jugular veins, a narrowing pulse pressure, and a muffled heart sound are seen in what conditions?

cardiac tamponade

Hemoptysis is defined as?

coughing up blood

What does a crackly feeling to the skin above the chest indicate

crepitus or subcutaneous emphysema it indicates air escaping from a lacerated lung

A 29 year old woman was in a car crash and she struck the steering wheel, she is complaining of chest pain. her airway is open, RR 24 and she is coughing up blood, pulse is 130 rapid and weak, BP is 90/58. She is blue around her lips and so are her fingers. When you expose the chest she tells you it hurts and points to a bruise spot. Which of the following is a symptom

cyanosis=sign rapid, weak pulse=sign hemoptysis=sign *pain at the site of injury*

The ___ separates the thoracic cavity from the abdominal cavity.

diaphragm

If the amount of tidal volume decreases, then the minute volume will drop along with it.

example: if you move 600 ml at the normal rate if 12 breaths/min, then the minute ventilation is 7,200 ml 600x12=7,200 0r 600x16=9,600

surfactant

fluid between the parietal and visceral pleura

Cyanosis indicates what?

inadequate respiration

Common signs and symptoms of tension pneumothorax include?

increased respiratory distress distended neck veins tracheal deviation away from the injured site

pulmonary contusion

injury or bruising of the lung tissue that results in hemorrhage

What is an open chest injury?

injury where there is penetration to the chest wall

How do you treat a hemothorax?

it can only be treated by a surgeon

What is traumatic asphyxia

it is a sudden, severe compression of the chest

When a person is lying supine at the end of exhalation, the diaphragm?

may rise as high as the nipple line

thoracic cage = chest diaphragm =separates chest from the abdomen inhalation = chest rises exhalation = chest falls hemophysis

mediastinum = center cavity of thorax open chest injury =penetrating wound closed chest injury = unusually blunt trauma aorta = major artery in the chest pericardium =sac around the heart

If a persons tidal volume decreases, but his or her respiratory rate remains unchanged?

minute volume will decrease

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a

myocardial contusion

A_____ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms

myocardial contusion

20 year old man was playing basketball and suddenly developed chest pain and difficulty breathing. RR24, pulse 140, BP 160/90. upon listening to the chest, you notice diminished breath sounds on the left. this pt is suffering from an

open 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 patient with blunt trauma who is holding the lateral side of his chest and breathing rapid and shallow is most likely suffering from?

rib fractures

What is pleuritic pain

sharp, sticking pain upon breathing due to damage to the pleural space

What are 3 large blood vessels in the chest that can result in massive hemorrhaging?

the aorta the pulmonary arties the 4 main pulmonary veins

What is the principal reason for concern of a chest injury

the body has no means of storing oxygen

Ventilation

the body's ability to move air in and out of the chest and lung tissue

Respiration

the exchange of gases in the alveoli of the lung tissue

pericardium

the fibrous sac that surrounds the heart

Elevation of the rib cage during inhalation occurs when?

the intercostal muscles contract

What is the pericardial sac

the protective membrane around the heart

What happens to an unrestrained person in a vehicle crash

they keep moving

thoracic aortic aneurysm

this occurs when a weakened portion of the wall of the aorta develops a false lumen or bubble and eventually ruptures

closed chest injury

this type of chest injury results fro blunt trauma where the skin is not broken

Air is supplied to the lungs via the?

trachea

Paradoxical motion of the chest refers to:

unequal expansion of the chest wall

Pleural fluid is contained between the

visceral and the parietal pleurae

hemothorax

when blood collects in the pleural space

What happens on inhalation?

-the intercostal muscles contract, elevating the rib cage. -the diaphragm contracts. -air enters through the nose and mouth.

lateral collisions cause what % of injuries to the aorta

25%

Deformed steering wheel is a result of which numbered collision

2nd

Aortic rupture is a result of which numbered collision

3rd

commotion 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 causing ventricular fibrillation

myocardial contusion

A bruise of the heart muscle.

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 chest wall is effectively detached from the rest of the thoracic cage.

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.

traumatic asphyxia

A pattern of injuries seen after a severe force is applied to the chest, forcing blood from the great vessels back into the head and neck.

spontaneous pneumothorax

A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.

A flail chest occurs when:

A segment of the chest wall is detached from the thoracic cage

When bandaging an open chest wound, what is the minimum number of sides that have to be taped down?

A. One B. Two C. Three D. Four answer is C

16 year old boy was hit in the ribs on the left side. his breathing is shallow at RR22, pulse is regular and strong, you are able to rule out spinal trauma. What position do you transport him in?

A. Position of comfort B. Supine C. Prone D. Recovery answer is A

17 year old girl was hit in the chest with a lawn dart, she is conscious and able to talk, her airway is open, but her breathing is becoming progressively more difficult. her pulse is rapid and weak and she has a radial pulse. Upon examining of her chest you find a penetrating injury with a sucking sound as she breaths, how do you manage this wound?

A. apply O2 by nasal cannula B. stabilize the c-spine C. use a 4 x4 gauze pad D. use a occlusive dressing answer is D

37 year old was accidental shoot, his airway is open, RR 24, his pulse is rapid and weak, Upon exposing his chest you find a sucking chest wound. you should?

A. take a BP B. cover the wound C. continue your assessment D. transport immediately Answer is B

57 year old man was kicked in the chest by a horse, his breathing is labored RR2o, pulse is rapid and regular, Upon examination of his chest, you notice paradoxical movement on the right chest wall. You should?

A. take spinal precautions B. put the patient in a position of comfort C. provide O2 by nasal cannula D. stabilize the flail segment answer is D

apnea

Absence of breathing

If the lung is collapsed pasted 30% to 40% you may hear what type of breath sounds?

Absent breath sounds on that side, this is a significant sign of chest trauma.

pneumothorax

Accumulation of air or gas in the pleural space

An open pneumothorax occurs when?

Air enters the pleural space from outside the body

An pneumothorax is defined as?

An accumulation of air in the pleural space

sucking chest wound

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound. See also open pneumothorax.

simple pneumothorax

Any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient.

What is a sign or symptom of a chest injury?

Bruising of the chest wall crepitus with palpation of the chest unequal expansion of the chest wall

The phrenic nerve controls the diaphragm and exit the spinal cord at?

C3, C4, and C5

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 likely called

Commotio cordis

cardiac tamponade

Compression of the heart due to fluid or blood collection in the pericardial sac, leading to decreased cardiac output.

dyspnea

Difficult breathing

tachypnea

Rapid respiration

What is Beck's triad

S/S of cardiac tamponade -distended or engorge jugular veins -a narrowing pulse -muffled heart sounds

hypovolemic shock

S/S: rapid weak pulse and low BP

spontaneous pneumothorax

S/S: sudden chest pain and shortness of breath without a cause

hemopneumothorax

The accumulation of blood and air in the pleural space of the chest.

Belly breathing indicates what?

a spinal cord injury at or above the C6 and C7 when patient breathes entirely with the diaphragm

tension pneumothorax

an accumulation of air or gas in the pleural space that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.

A sucking chest wound should be treated with:

an occlusive dressing

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

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.