Chapter 29 Chest Injuries

A construction foreman was stabbed with a screwdriver in the right anterior chest by an angry employee. Prior to your​ arrival, he removed the screwdriver. He is alert and oriented and complaining of pain to the injury site. Your primary assessment reveals an open​ airway, adequate​ breathing, and strong radial pulse. Based on these​ findings, which of the following would be done​ first?

. Evaluate the patient SpO2 level.

The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes what​ statement?

A tension pneumothorax causes cardiac output to​ decrease; a simple pneumothorax does not affect cardiac​ output

A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary​ assessment, which of the following signs​ and/or symptoms would concern you that she is suffering from a tension​ pneumothorax?

Absent breath sounds on the​ right, distended neck​ veins, tracheal deviation to the left

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

Assist ventilations with a bag-valve mask

An unrestrained female driver hit a utility pole at a moderate rate of speed and struck the steering wheel with her chest. Her airway is​ open, and she states that it is painful to breathe. Her pulse is moderate in strength and irregular. Breath sounds are equal​ bilaterally, and there is no jugular venous distention noted. Assessment of her chest reveals bruising and instability to the sternum. When​ asked, she denies any past medical history. Based on this mechanism and assessment​ findings, the EMT should be suspicious for what​ condition?

Cardiac contusion

A​ 14-year-old male was struck in the chest by a baseball. On your​ arrival, he is in cardiac arrest. What is the most likely explanation for the sudden cardiac​ arrest?

Commotio cordis

You have been called to a New​ Year's party for a male patient who was stabbed in the anterior chest. According to​ partygoers, the patient went outside with another male and was stabbed. Fifteen minutes​ later, he was found in the snow and 911 was called. When assessing this​ patient, what finding would you consider most serious and warrant immediate​ attention?

Decreased breath sounds to the left lung

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

Reduced tidal volume due to shifting of expiratory air from the uninjured side to the injured side is a common result of which​ injury?

Flail segment

A patient has been shot in the chest with a rifle. Assessment reveals a deteriorating level of consciousness and inadequate breathing. Positive pressure ventilation is being​ administered, and the entrance​ wound, located midclavicular at the second intercostal space on the left side of the​ chest, has been covered. Your next action would be​ to:

Look for an exit wound

Which of the following organs or structures does NOT reside within the mediastinum?Select one: a. Trachea b. Venacavae c. Lungs d. Esophagu

Lungs

A​ 23-year-old female has been involved in a serious motor vehicle collision. Which assessment finding best indicates that she has a flail​ segment?

Paradoxical chest wall movement

Your patient was stabbed in the left anterior chest wall at the midclavicular line and fourth rib. His breath sounds are​ normal, but he is in severe distress and obvious shock. What do you suspect has happened to​ him?

Pericardial tamponade

What mechanism of injury produces the conditions for traumatic​ asphyxia?

Person pinned between a truck and wall of a building

Damage to tissues of what thoracic​ structure(s) will cause impairment of ventilation and a​ pneumothorax?

Pleural membranes

Assessment findings of a patient ejected from a motorcycle indicate that he has a flail chest wall segment to his right anterior chest. He exhibits labored breathing and an SpO2 at​ 94%. Breath sounds are clear and equal bilaterally. The segment has been​ stabilized, and you are prepared to start positive pressure ventilation. Given these assessment​ findings, what type of injury underlying the flail segment is your primary​ concern?

Pulmonary contusion

Which term is used for bleeding that occurs in and around the​ alveoli, reducing oxygen​ exchange?

Pulmonary contusion

In which thoracic injury is a mechanical collapse of the vena cava​ involved?

Tension pneumothorax

What occurs when the diaphragm and intercostal muscles​ contract?

The thoracic cage​ enlarges, causing a decrease in intrathoracic and intrapulmonary pressures.

A flail chest occurs when:

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

While jogging, a 19 year old male experienced an acute onset 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

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. a. suspect a severe hemopneumothorax. b. perform a secondary assessment. c. aggressively manage his airway. d. request a paramedic ambulance.

aggressively manage his airway

An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs​ when:

air accumulates around the​ lung, causing a portion of it to collapse.

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

When you are treating a patient who sustained a rib​ fracture, you should administer oxygen if the patient is in respiratory distress​ and:

apply a sling and swathe to the patient.

Closed chest injuries are typically caused by ________?

blunt trauma

Pulmonary contusions are serious injuries because​ they:

can interfere with oxygen exchange.

You are on the scene of a shooting. Your assessment reveals a​ 23-year-old male who has been shot twice. The first wound is to the left lower quadrant of the abdomen and is actively bleeding. The second wound is to the left lateral chest and bubbles every time the patient takes a breath. Your immediate action would​ be:

cover the chest wound with a gloved hand.

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

diaphram

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 breath sounds. As your partner is supporting her ventilations, you should:

immediately request ALS support

You arrive at the scene of a major motor vehicle crash. The patient, a 50 year old female, was removed form 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

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

may rise as high as the nipple line

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.

During your physical examination of a patient who was hit in the chest with a baseball​ bat, you notice that a small section of his ribcage sinks when he inhales and moves outward when he exhales. This is known​ as:

paradoxical movement.

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 assessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing.

The _______________ nerves control the diaphragm.Select one: a. costal b. vagus c. phrenic d. intercostal

phrenic

In order to avoid exacerbating a patients 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

A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused and breathing rapidly and shallowly. After manually stabilizing the flail section of the chest​ wall, the EMT best treats this condition​ by:

providing positive pressure ventilation.

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 saturations is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:

pulmonary contusion

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

requires prompt ventilation and oxygenation.

During the secondary​ assessment, the EMT notes instability and a flail segment to a​ patient's lower left lateral chest. The EMT would​ immediately:

stabilize the segment with his hand.

A patient has been involved in a motorcycle crash and has a flail segment to the right lateral chest. His airway is open and he is breathing poorly at 24 breaths per minute with a decreasing SpO2. The EMT shows that he is appropriately caring for this injury when​ he:

starts positive pressure ventilation.

The​ EMT's primary and first concern with any open injury to the chest​ is:

stopping air entry.

Patients with chest injuries will often present with _______?

tachypnea

Assessment findings on a​ 33-year-old female who has been shot in the right side of the chest indicate that she is suffering from a pneumothorax. As you care for this​ patient, your primary concern is monitoring the injury​ for:

tension pneumothorax.

If a patient has an open chest wound that allowed air to accumulate into the pleural cavity to the point at which the lung is totally collapsed and is starting to shift to the other​ side, this additional complication is known​ as:

tension pneumothorax.

The danger of blood collecting inside the pericardial sac after blunt chest wall trauma is​ that:

the heart cannot contract as effectively.

Children are often "belly breathers" because _________?

their intercostal muscles are not developed

Pleural fluid is contained between the: a. visceral pleura and the lung. b. parietal pleura and the chest wall. c. visceral and parietal pleurae. d. parietal pleura and the heart.

visceral and parietal pleurae.

Which statement made by an EMT demonstrates an understanding of chest​ trauma?

​"Closed chest injuries are caused by blunt trauma and can be just as serious as open chest​ injuries."

A confused​ 62-year-old female fell at​ home, hitting the side of a table with her chest. Assessment reveals instability to the left lateral chest accompanied by minor bruising in the same area. She complains of intense pain every time she breathes. Her airway is​ patent, breathing is rapid and​ shallow, and skin warm and nondiaphoretic. Vital signs are pulse​ 112, respirations​ 24, and blood pressure​ 132/64 mmHg with SpO2 at​ 90%. Breath sounds are shallow but equal to both lungs. Based on those​ findings, you should treat this patient for what​ life-threatening condition?

Hypoxia

An alert and oriented young male fell 5 feet from a​ stage, impacting a metal railing with the right side of his​ chest, just under his armpit. The primary assessment is negative for life​ threats, although he does complain of very painful breathing and has remarkable tenderness and crepitus over the 5th rib laterally in this area. Throughout​ care, what action is essential to​ perform?

Monitor breath sounds.

You are transporting a young and healthy female patient who was involved in a motor vehicle collision and struck her chest on the steering column. Although the primary assessment reveals no life​ threats, she does have redness to her​ sternum, as well as pain and tenderness. Breath sounds are clear and present bilaterally and vital signs are within normal limits. As you transport and reassess​ her, what sign or symptom would be most​ concerning?

Onset of an irregular heartbeat

Your patient was shot in the right upper chest. Upon inspecting the​ wound, you notice that is bubbles each time the patient exhales. Which injury is MOST​ likely?

Open pneumothorax

A young male patient is​ self-extricated after hitting a telephone pole and rolling his car several times at a high rate of speed. He is spitting blood and has a large area of tenderness and instability to the left side of his chest. On scene you did not observe any paradoxical motion of the chest wall. The patient remains alert and oriented with stable vital​ signs, but continually complains of painful breathing. During​ transport, what is it essential that you​ do?

Reassess for paradoxical motion of the chest wall.

You suspect a trauma patient to be suffering from a hemothorax to the left lung. What assessment finding would reinforce this​ suspicion?

Respiratory distress and the signs and symptoms of shock

Elevation of the rib cage during inhalation occurs when: a. intrathoracic pressure decreases b. the diaphragm descends. c. the intercostal muscles contract. d. abdominal contents descend.

intercostal muscles contract

A simple pneumothorax:

is commonly caused by blunt chest trauma

A​ middle-aged male has been stabbed once in the left anterior chest. His airway is​ patent, respirations​ tachypneic, pulse weak and​ rapid, and skin cool and diaphoretic. Breath sounds are clear and equal bilaterally. The vital signs​ are: pulse​ 140, respirations​ 24, blood pressure​ 100/78 mmHg, and SpO2​ 96% on supplemental oxygen. Given this​ presentation, you would have a high index of suspicion​ for:

pericardial tamponade.

An unrestrained​ 32-year-old female motorist hit a utility pole head on at 45 mph. The car sustained extensive damage. She has an open​ airway, breathing poorly at 32 breaths per​ minute, and is responsive to painful stimuli. The radial pulse is rapid and​ weak, and her skin is cool and cyanotic. Breath sounds are decreased on the right side. Emergency Medical Responders are maintaining manual​ in-line stabilization. Your next action would be​ to:

start positive pressure ventilation.

On scene at a college football​ game, a wide receiver is unresponsive after colliding with another player and forcefully taking a helmet to the chest. The athletic trainer reports that the patient is pulseless and apneic. Given the mechanism of injury and​ patient's presentation, which instruction would be​ appropriate?

​"Let's apply the AED and follow all​ prompts."