Chapter 34 - Chest Trauma

When assessing a patient who sustained blunt trauma to the chest, which one of the following assessment findings is most indicative of an injury to the lung?

Ability to speak a few words and then gasp

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

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

A construction foreman has been stabbed in the right anterior chest with a screwdriver by an angry worker. He is conscious and oriented and complaining of pain to the injury site. Prior to your arrival, he removed the screwdriver. Your primary assessment reveals a patent airway, adequate breathing, and strong radial pulse. Based on these findings, you should:

Administer oxygen through a nonrebreather mask

A patient has been shot in the chest with a rifle. Your assessment reveals a decreasing level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and you have covered the entrance wound located midclavicular at the second intercostal space on the left side of the chest. Which one of the following should you do next?

Look for an exit wound.

A 39-year-old male has been stabbed once in the anterior chest. When notifying the emergency department of the patient's arrival, you inform them that the patient has suffered what type of injury?

Open chest injury

Your patient was involved in a serious motor-vehicle collision. Which one of the following assessment findings best helps to determine that the patient has a flail segment?

Paradoxical chest wall movement

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 a 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

You suspect a trauma patient to be suffering from a hemothorax to the left lung. Which one of the following assessment findings should reinforce your suspicion?

Respiratory distress and the signs and symptoms of shock

A 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and he is complaining of shortness of breath. When he speaks he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which one of the following should you do first?

Suction the blood from the airway.

Which one of the following best describes a flail segment?

Two or more adjacent ribs broken in two or more places

A paramedic has asked that you apply a dressing over a sucking chest wound to the left anterior chest. Which one of the following should you use to cover the injury?

Vaseline guaze

A construction foreman has been stabbed in the right anterior chest with a screwdriver by an angry worker. He is conscious and oriented and complaining of pain to the injury site. Prior to your arrival, he removed the screwdriver. Your initial assessment reveals a patent airway, adequate breathing, and strong radial pulse. Based on these findings, you should:

administer oxygen through a nonrebreather mask.

An Emergency Medical Responder asks you to explain a pneumothorax. Your response should be that it occurs when:

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

You have applied a nonporous dressing to a stab wound on a patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides. Your best response is that taping the dressing on three sides:

allows trapped air to escape on exhalation

You are managing a patient with a large flail segment to the right lateral chest. As such, you should recognize that the immediate threat to life is:

hypoxia

Care for an open chest wound and an abdominal evisceration are similar in that:

occlusive dressings are placed over both wounds.

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 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 inadequately at 24 breaths per minute. The EMT shows that he is appropriately caring for this injury when he:

secures a rolled towel over the fractured ribs.

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

stabilize the segment with his hand

The EMT showed that he understands the difference between a pneumothorax and a tension pneumothorax when he made which one of the following statements?

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

Which one of the following statements made by an EMT shows an understanding of chest trauma?

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

An adult female is found unresponsive after being shot in the chest. Which one of the following EMT statements about this patient is of most concern?

"She is getting more difficult to ventilate."

On scene a paramedic directs you to help another EMS crew with a patient who was hit by a passenger van that ran into a crowd. As you approach the patient, which one of the following scene size-up clues seemingly indicates the patient is suffering from traumatic asphyxia?

Bluish discoloration to the neck and face

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

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 makes a sucking sound every time the patient takes a breath. The initial action of the EMT should be which one of the following?

Cover the chest wound with a gloved hand

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, which finding should the EMT consider most serious and warrant immediate attention?

Decreased breath sounds to the left lung

When assessing a patient, which one of the following signs or symptoms is most indicative of the patient suffering from a pneumothorax?

Decreased breath sounds to the right lung

A patient has sustained an injury to his mediastinum. Based on the anatomy of his chest, which one of the following structures has been injured?

Esophagus

A confused 62-year-old female fell at home, impacting the side of a table with her chest. Your assessment reveals instability to the left lateral chest accompanied by some minor bruising to the area. She is complaining of significant pain every time she breathes. Her airway is patent, her breathing is rapid and shallow, and her skin is warm and nondiaphoretic. Vital signs are pulse 112, respirations 24, and blood pressure 132/64 mmHg with SpO2 at 91%. Breath sounds are shallow but equal to both lungs. Based on those findings, you should treat this patient for what life-threatening condition?

Hypoxia

You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. Which one of the following actions is it critical for you to take?

Lift one side of the dressing during expiration

You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. Which one of the following actions is it critical for you to take?

Lift one side of the dressing during expiration.

You are transporting a 19-year-old male who was shot in the chest. On scene you covered the wound with an appropriate dressing. Now, as you conduct your reassessment, you note that the patient is tachypneic and complaining of difficulty breathing. Breath sounds on the side of the injury are also diminished. Which one of the following should you do immediately?

Lift the dressing from the wound for several seconds.

An unrestrained 32-year-old female motorist hit a utility pole head on at 35 mph. The car sustained extensive damage. She exhibits labored respirations and is responsive to painful stimuli with an open airway. She is breathing shallowly at 32 breaths per minute. 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 should be to

start positive pressure ventilation.

An unrestrained 32-year-old female motorist hit a utility pole head on at 35 mph. The car sustained extensive damage. She exhibits labored respirations and is responsive to painful stimuli with an open airway. She is breathing shallowly at 32 breaths per minute. 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 should be to:

start positive pressure ventilation.

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. During your reassessment, your primary concern is monitoring the injury for:

tension pneumothorax