Chapter 27

30. You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% 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

21. A 33-year-old male was stabbed in the left anterior chest. He is conscious, but is experiencing signs of shock. Further assessment reveals that his jugular veins are distended and his breath sounds are bilaterally equal and clear. This patient is MOST likely experiencing:

a pericardial tamponade.

19. A flail chest occurs when:

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

11. Pneumothorax is MOST accurately defined as:

accumulation of air in the pleural space.

26. 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. During your focused exam, you note that he has diminished breath sounds over the left side of the chest. You should:

administer oxygen and transport to the hospital.

25. 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:

aggressively manage his airway.

12. an open pneumothorax occurs when:

air enters the pleural space from outside the body.

17. Subcutaneous emphysema is an indication that:

air is escaping into the chest wall from a damaged lung.

18. Patients with rib fractures will commonly:

breathe rapidly and shallowly.

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

collapsed jugular veins.

6. Hemoptysis is defined as:

coughing up blood.

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

diaphragm.

13. A spontaneous pneumothorax would MOST likely occur as the result of:

exertion of a person with a congenital lung defect.

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

hematemesis

27. 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.

15. Definitive care for a tension pneumothorax involves:

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

29. 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 unconscious, tachycardic, and diaphoretic. Your rapid trauma assessment reveals bilaterally 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.

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

may rise as high as the nipple line.

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

myocardial contusion.

10. Asymmetry of the chest wall occurs when:

one side of the chest wall does not expand during inhalation.

23. You have sealed an open chest wound on 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.

5. The ________ nerves control the diaphragm.

phrenic.

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

pleurisy.

28. 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 applying 100% oxygen, you should:

prepare for immediate transport.

22. Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

provide some form of positive-pressure ventilation.

9. A patient who represents with profound cyanosis following a chest injury:

requires prompt oxygenation and ventilation.

16. When assessing a patient with a hemothorax, you would MOST likely find:

signs and symptoms of shock.

24. During your rapid trauma assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should:

stabilize the chest wall with a bulky dressing

4. Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

2. Pleural fluid is contained between the:

visceral and parietal pleurae.