Chapter 34 Quiz - Chest Trauma

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"

You have arrived on scene of a middle school karate exhibition, a 13 year old boy was kicked in the chest and collapsed almost immediately afterward. Given the mechanism of injury and patient's presentation, which steps would be most appropriate given the information provided?

"Let's apply the AED and follow the audio prompts"

A new EMT who just started working with your EMS system asks you to describe a flail segment. Which statement best describes this injury?

"Two or more adjacent ribs are broken in two or more places"

When assessing a patient who sustained blunt trauma to the chest, which assessment finding is most indicative of an injury to the lung, impairing adequate ventilations?

Ability to speak only a few words, following by a gasp

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

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

An EMR 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

On scene, a paramedic directs you to help another EMS crew who is caring for a patient who was hit and trapped under a passenger van that ran into a crowd. As you approach the patient, which scene size-up clue seemingly indicates that the patient is suffering from traumatic asphyxia?

Bluish discoloration to the neck and face

A middle aged male patient has been stabbed once in the right anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear on the left and severley diminished on the right. JVD and tracheal deviation are present. His SpO2 is 93% on supplemental oxygen via BV. The vital signs are pulse, 140 breaths/min; respirations, 28 breaths/min, and blood pressure, 100/78 mmHg. Your next action should be to:

Call for an ALS intercept en-route to the ED and lift the dressing to see if air escapes during exhalation

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 lateral chest and bubbles every time the patient exhales. What would your immediate and best action be?

Cover the chest wound with a gloved hand

When assessing a patient, which sign or symptom is most indicative of a pneumothorax?

Decreased breath sounds to the right lung

Which of these statements is MOST accurate regarding the assessment and management of a geriatric patient who sustained chest wall trauma?

Geriatrics do not compensate as well and tend to decompensate more rapidly

You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. Which action is critical given this situation?

Lift one side of the dressing during exhalation

You are transporting a 19 year old male with a gunshot wound to the chest. On scene, you covered the wound with an appropriate dressing. Now, as you reassess the patient, you note that the patient is tachypneic and complains of increased difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be to:

Lift the dressing from the wound briefly during exhalation

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, which is located midclavicular at the second intercostal space on the left side of the chest, has been covered with an occlusive dressing. Your next priority action would be to:

Look for a bullet exit wound posteriorly

An alert and oriented young male fell 5 feet from a stage, impacting a metal railing with the right side of his chest, inferior to 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 fifth and sixth ribs laterally in this area. throughout care, which action is essential to preform?

Monitor breath sounds

You are transporting a young and healthy female patient who was involved in a motor vehicle collision, during which she struck her chest on the steering column. Although the primary assessment reveals no life threats, the patient 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 this patient, which sign or symptom would indicate the immediate need for ALS?

Onset of an irregular heartbeat

A 39 year old male has a single stab wound to the anterior chest. When notifying the emergency department, you inform them that the patient is a/an:

Open chest injury

Asherman, Halo and Bolin devices are commercially available devices to use for which injury?

Open chest wound

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 breaths/min; respirations 24 breaths/min; blood pressure 100/84 mmHg; and SpO2 96% on supplemental oxygen. JVD is present. Given this presentation, you would have a high index of suspicion for:

Pericardial tamponade

A paramedic has asked that you apply a dressing over a sucking chest wound. Which option is the best choice to cover this injury?

Petroleum gauze

Damage to which thoracic tissues can cause impairment of ventilation from developing pneumothorax?

Pleural membranes

A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused, her breathing is rapid and shallow, and breath sounds are diminished bilaterally. The EMT best treats this condition by:

Providing positive pressure ventilation with oxygen attached

Select those injuries/conditions which geriatric patients are more susceptible to following blunt chest trauma (but no more than three):

Pulmonary contusions, Pneumonia, Rib fractures

You suspect a trauma patient has a hemothorax to the left lung. Which assessment finding would reinforce this suspicion?

Respiratory distress and the signs and symptoms of shock

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

Start 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 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 ventilations

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

Stopping air entry

A 42 year old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and the patient now complains 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 intervention should you perform first?

Suction the blood from the airway

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

Tension pneumothorax

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

Uneven chest wall movement during breathing