Chapter 29 EMT

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? a. Engorged jugular veins b. Widening pulse pressure c. Diminished breath sounds d. A rapid, irregular pulse

a. Engorged jugular veins

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

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

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

a. administer oxygen and transport to the hospital.

The thoracic cavity is separated from the abdominal cavity by the: a. diaphragm. b. anterior rib cage. c. intercostal margin. d. costovertebral angle.

a. diaphragm.

A simple pneumothorax: a. is commonly caused by blunt chest trauma. b. often has a nontraumatic cause. c. is caused by penetrating chest trauma. d. heals on its own without any treatment.

a. is commonly caused by blunt chest trauma.

An open pneumothorax occurs when: a. a fractured rib perforates the tissue of the lung. b. air enters the pleural space from outside the body. c. extreme pleural pressure causes the lung to rupture. d. air enters the pleural space from a perforated lung.

b. air enters the pleural space from outside the body.

When a person is lying supine at the end of exhalation, the diaphragm: a. contracts and flattens inferiorly. b. may rise as high as the nipple line. c. is less prone to penetrating trauma. d. descends below the level of the navel.

b. may rise as high as the nipple line.

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: a. begin ventilatory assistance. b. partially remove the dressing. c. begin rapid transport at once. d. call for a paramedic ambulance.

b. partially remove the dressing.

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: a. flail chest. b. pneumothorax. c. cardiac tamponade. d. myocardial contusion.

b. 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: a. apply an AED and assess his BP. b. prepare for immediate transport. c. determine if he has cardiac problems. d. apply bulky dressings to the sternum.

b. prepare for immediate transport.

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: a. traumatic asphyxia. b. pulmonary contusion. c. massive hemothorax. d. tension pneumothorax.

b. pulmonary contusion.

Patients with chest injuries will often present with _______. a. agonal respirations b. tachypnea c. Kussmaul respirations d. Cheyne-Stokes respirations

b. tachypnea

Closed chest injuries are typically caused by _______. a. penetrating trauma b. high-velocity weapons c. blunt trauma d. flying debris

c. blunt trauma

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: a. often breathes at a slower rate because of lung damage caused by the injury. 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. will maintain adequate minute volume if his or her respiratory rate stays the same.

c. must increase his or her respiratory rate to maintain adequate minute volume.

spinal cord injury at the level of C7 would MOST likely result in: a. immediate cardiac arrest. b. paralysis of the diaphragm. c. paralysis of the intercostal muscles. d. paralysis of all the respiratory muscles.

c. paralysis of the intercostal muscles.

Which of the following is most likely to cause immediate death? a. Myocardial contusion b. Pulmonary contusion c. Aortic dissection d. Aortic rupture

d. Aortic rupture

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: a. insert an oropharyngeal airway. b. obtain a set of baseline vital signs. c. perform a focused secondary exam. d. immediately request ALS support.

d. immediately request ALS support.

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: a. massive hemothorax. b. tension pneumothorax. c. pericardial tamponade. d. laceration of the aorta.

d. laceration of the aorta.

Immediately life-threatening chest injuries must be found and managed during the _______. a. scene size-up b. patient history c. secondary assessment d. primary assessment

d. primary assessment

Children are often "belly breathers" because _______. a. their diaphragm is not functional b. they are routinely hypoxic c. they are consciously controlling ventilations d. their intercostal muscles are not developed

d. their intercostal muscles are not developed