EMS chapter 29 chest injuries

69.spontaneous pneumothorax::

A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space

71.tension pneumothorax::

An accumulation of air or gas in the pleural space that progressively increases pressure in the chest that interferes with cardiac function with potentially fatal results.

63.occlusive dressing::

An airtight dressing that protects a wound from air and bacteria; a commercial vented version allows air to passively escape from the chest, while an unvented dressing may be made of petroleum jelly-based (Vaseline) gauze, aluminum foil, or plastic.

82.When a patient sustains a spinal cord injury above the C3 region, which of the following is likely to happen?::

An injury above C3 is likely to cause the patient to lose his/her ability to breathe entirely.

59.open chest injury::

An injury to the chest in which the chest wall itself is penetrated by a fractured rib or, more frequently, by an external object such as a bullet or knife.

58.closed chest injury::

An injury to the chest in which the skin is not broken, usually caused by blunt trauma.

67.sucking chest wound::

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound. See also open pneumothorax.

66.open pneumothorax::

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound.

70.simple pneumothorax::

Any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient.

87.Which of the following blood vessels can be lacerated by a fractured rib?::

Aorta

2.Which of the following is most likely to cause immediate death?::

Aortic rupture

40.Distended jugular veins, narrowing pulse pressure, and muffled heart tones are collectively known as _______.::

Beck's triad

79.Myocardial Contusion::

Bruising of the heart muscle

80.Commotio cordis::

A blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a person's heartbeat.

72.hemothorax::

A collection of blood in the pleural cavity.

76.flail chest::

A condition in which three or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of the chest wall is effectively detached from the rest of the thoracic cage.

61.crepitus::

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

68.flutter valve::

A one-way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve; may also be part of a commercial vented occlusive dressing.

65.pneumothorax::

A partial or complete accumulation of air or gas in the pleural space

78.traumatic asphyxia::

A pattern of injuries seen after a severe force is applied to the chest, forcing blood from the great vessels back into the head and neck

45.You are transporting a stable patient with a possible pneumothorax. The patient is receiving high-flow 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

74.cardiac tamponade (pericardial tamponade)::

Compression of the heart as the result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output.

64.________ in a patient with a chest injury is a sign that the blood is not being oxygenated sufficiently.::

Cyanosis

4.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

60.Tachypnea::

Increased respiratory rate

77.pulmonary contusion::

Injury or bruising of lung tissue that results in hemorrhage

84.Two most common injuries caused by penetrating chest trauma?::

Open pneumothorax and cardiac tamponade

86.You are treating a patient who fell hard on her right side when she fell off a bike. Exposure of the patient's chest reveals a large bruise on the lateral aspect of the right side of the chest. When you palpate the area, the patient yells out in extreme pain and states that she cannot take a deep breath. What condition should you suspect?::

Rib fractures

85.What is the best position in which to place a patient when you want to assess for jugular vein distention?::

Sitting at a 45 degree angle

73.hemopneumothorax::

The accumulation of blood and air in the pleural space of the chest.

75.pericardium::

The fibrous sac that surrounds the heart.

62.paradoxical motion::

The motion of the portion of the chest wall that is detached in a flail chest; the motion—in during inhalation, out during exhalation—is exactly the opposite of normal chest wall motion during breathing

81.What is ventilation?::

Ventilation is the body's ability to move air in and out of the chest and lung tissue.

51.A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred?::

Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

97.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.

55.a flail chest occurs when::

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

44.Pneumothorax is MOST accurately defined as::

accumulation of air in the pleural space

57.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::

administer oxygen and transport to the hospita

100.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.

56.an open pneumothorax occurs when::

air enters the pleural space from outside the body

96.Subcutaneous emphysema is an indication that::

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

1.Closed chest injuries are typically caused by _______.::

blunt trauma

22.may result in fractures to the ribs and the sternum::

blunt trauma

49.Patients with rib fractures will commonly::

breathe rapidly and shallowly

35.when blood collects in the space between the pericardial sac and the heart. this condition results in pressure building up inside the pericardial sac until the heart cannot pump effectively; cardiac arrest may occur quickly::

cardiac tamponade

20.often the result of blunt force trauma::

closed injuries

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

collapsed jugular veins

34.occurs from direct blows to the chest during a critical portion of the patient's heartbeat. it may result in immediate cardiac arrest::

commotio cordis

91.Hemoptysis is defined as::

coughing up blood.

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

diaphragm.

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

exertion of a person with a congenital lung defect.

41.Paradoxical motion is a sign of a _______.::

flail chest

30.three or more ribs broken in two or more places what ventilation may be particularly important for a patient with a flail chest that compromises ventilation::

flail chest segment, postive-pressure ventilation

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

hematemesis

29.is the result of blood accumulating in the plueral space after a traumatic injury when the vessels of the lung are lacerated and leak blood::

hemothorax

83.You are assessing a patient who sustained a blunt force chest injury during a motorcycle accident. There are no obvious signs of external bleeding, but the patient is hypovolemic and there are decreased breath sounds on the left side. Which of the following should you suspect?::

hemothorax

31.all patients with chest injuries should recieve::

high-flow oxygen or ventilation with BVM

6.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.

39.The pliability of the pediatric rib cage _______.::

increases the risk of internal injury

47.the treatment for relieving a tension pneumothorax involves::

inserting a needle through the rib cage into the pleural space

95.Definitive care for a tension pneumothorax involves::

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

7.A simple pneumothorax::

is commonly caused by blunt chest trauma.

13.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::

laceration of the aorta.

23.must be addressed immediately during the primary assessment even before airway or breathing concerns::

life-threatening hemorrage

38.Hemoptysis indicates damage to the _______.::

lungs

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

may rise as high as the nipple line.

36.The esophagus, trachea, and great vessels of the body are located in the _______.::

mediastinum

53.If a person's tidal volume decreases, but his or her respiratory rate remains unchanged::

minute volume will decrease

3.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.

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

myocardial contusion

33.this condition may have the same signs and symptons as a heart attack, including an irregular pulse, this injuryis an injury to the heart muscle from trauma not from a heart attack::

myocardial contusion -bruising of the heart muscle after traumatic injury

93.Asymmetry of the chest wall occurs when::

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

21.are the result of an object penetrating the skin and/or chest wall::

open injuries

19.chest injuries are classifed as::

open or closed

25.when a penetrating injury creates a hole in the chest wall, you may hear a sucking sound as the patient inhales this is called::

open pneumothorax

10.A spinal cord injury at the level of C7 would MOST likely result in::

paralysis of the intercostal muscles.

15.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::

partially remove the dressing.

18.a penetrating chest injury has the potential to::

penetrate the lung and diaphragm and injure the liver or stomach

90.The ________ nerves control the diaphragm.::

phrenic

54.irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called::

pleurisy

28.may progress to a tension __ and cause cardiac arrest::

pneumothorax

24.any penetrating injury to the chest may result in air entering the pleural space and may cause what type of dressing should be used:

pneumothorax Occusive dressing

14.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::

pneumothorax.

8.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.

12.Immediately life-threatening chest injuries must be found and managed during the _______.::

primary assessment

98.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.

32.what may interfere with oxygen exchange in the lung tissue::

pulmonary contusion-bruising of or injury to lung tissue after traumatic injury

5.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::

pulmonary contusion.

52.A patient with a chest injury has a blood pressure of 100/60 mm Hg and a pulse rate of 120 beats/min. Which of the following additional findings should make you suspect a pericardial tamponade?::

repeats BP of 92/68 mmHg

92.A patient who presents with profound cyanosis following a chest injury::

requires prompt oxygenation and ventilation.

48.when assessing a patinet with a hemothorax, you will MOST likely find::

signs and symptons of shock

26.is the result of blunt trauma, such as fractured ribs::

simple pneumothorax

27.May be the result of rupture of a weak spot on the lung, allowing air to enter the pleural space and accumalate. this often results from nontraumatic injuries and may occur during times of physical activity such as excerise::

sponatenous pneumothorax

99.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.

16.Patients with chest injuries will often present with _______.::

tachypnea

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

the intercostal muscles contract.

9.Children are often "belly breathers" because _______.::

their intercostal muscles are not developed

42.Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of::

traumatic aortic rupture

37.The body's ability to move air in and out of the lungs is called _______.::

ventilation

88.Pleural fluid is contained between the::

visceral and parietal pleurae.