Module 29-Chest Injuries

open pneumothorax

"sucking chest wound" 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.

A flail chest occurs when:

a segment of the chest wall is detached from the thoracic cage.

Which of the following is most likely to cause immediate death?

aortic rupture

Patients with chest injuries will often present with _______.

tachypnea

What is ventilation?

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

open chest injury

the chest wall has been penetrated

Suspect hemothorax if

--signs and symptoms of shock without any obvious external bleeding or apparent reason for the shock rate --decreased breath sounds on the affected side, which is an indication that the lung is being compressed by the blood

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.

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.

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.

pneumothorax

A partial or complete accumulation of air in the pleural space.

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.

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.

occlusive dressing

An airtight dressing that protects a wound from air and bacteria; a commercial vented version allows air to passively escape from the chest, while an unvented dressing may be made of petroleum jelly-based (Vaseline) gauze, aluminum foil, or plastic.

closed chest injury

An injury to the chest in which the skin is not broken, usually caused by blunt trauma.

simple pneumothorax

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

Distended jugular veins, narrowing pulse pressure, and muffled heart tones are collectively known as _______.

Beck's triad

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?

Compression of the aorta and vena cava

cardiac tamponade

Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.

________ in a patient with a chest injury is a sign that the blood is not being oxygenated sufficiently.

Cyanosis

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

pulmonary contusion

Injury or bruising of lung tissue that results in hemorrhage.

When a patient sustains a spinal cord injury above the C3 region, which of the following is likely to happen?

Loss of the ability to breathe due to loss of ability of phrenic nerves to function

What are the two most common injuries caused by penetrating chest trauma?

Open pneumothorax and cardiac tamponade are the two common injuries caused by penetrating chest trauma

Important signs and symptoms of chest injury include:

Pain at the site of injury Pain localized at the site of injury that is aggravated by breathing Bruising to the chest wall Crepitus with palpation of the chest Any penetrating injury to the chest Dyspnea Hemoptysis Failure of the chest to expand normally with inspiration Rapid, weak pulse and low blood pressure Cyanosis around the lips or fingernails

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?

Repeat BP of 90/68 mm Hg

What is the best position in which to place a patient when you want to assess for jugular vein distention?

Sitting at a 45-degree angle

Hemopneumothorax

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

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.

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

Pneumothorax is defined as:

accumulation of air in the pleural space

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.

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

Which of the following blood vessels can be lacerated by a fractured rib?

aorta

hemothorax

blood in the pleural cavity

Closed chest injuries are typically caused by _______.

blunt trauma.

Patients with rib fractures will commonly:

breathe rapidly and shallowly.

myocardial contusion

bruising of the heart muscle

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

collapsed jugular veins

The thoracic cavity is separated from the abdominal cavity by the:

diaphragm

In which condition is it recommended you use positive-pressure ventilation?

flail chest

Paradoxical motion is a sign of a _______.

flail chest

Common signs and symptoms of a chest injury include all of the following, EXCEPT:

hematemesis.

You are assessing a patient and notice he has a collapsed jugular vein. What does this indicate?

hemothorax

You are assessing a patient who sustained a blunt force chest injury during a motorcycle accident. There are no obvious signs of external bleeding, but the patient is hypovolemic and there are decreased breath sounds on the left side. Which of the following should you suspect?

hemothorax

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 pliability of the pediatric rib cage _______.

increases the risk of internal injury

The treatment for relieving a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space.

A simple pneumothorax:

is commonly caused by penetrating chest trauma.

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:

laceration of the aorta

Hemoptysis indicates damage to the _______.

lungs

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

may rise as high as the nipple line.

The esophagus, trachea, and great vessels reside in the _______.

mediastinum

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will decrease.

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.

Which of the following are you likely to see in flail chest?

paradoxical motion

A spinal cord injury at the level of C7 would MOST likely result in:

paralysis of the intercostal muscles

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.

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:

pleurisy.

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 providing supplemental oxygen, you should:

prepare for immediate transport

Immediately life-threatening chest injuries must be found and managed during the _______.

primary assessment

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:

provide ventilation assistance with a BVM.

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:

pulmonary contusion

You are treating a patient who fell hard on her right side when she fell off a bike. Exposure of the patient's chest reveals a large bruise on the lateral aspect of the right side of the chest. When you palpate the area, the patient yells out in extreme pain and states that she cannot take a deep breath. What condition should you suspect?

rib fracture

When assessing a patient with a hemothorax, you will MOST likely find:

signs and symptoms of shock

Children are often "belly breathers" because _______.

their diaphragm is not functional

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

traumatic aortic rupture

The body's ability to move air in and out of the lungs is called _______.

ventilation