EMT Chapter 27 Chest Injuries

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: A. request a paramedic ambulance. B. suspect a severe hemopneumothorax. C. perform a secondary assessment. D. aggressively manage his airway.

aggressively manage his airway.

The phrenic nerves control the diaphragm and exit the spinal cord at: A. C3 and C4. B. C1, C2, and C3. C. C1 and C2. D. C3, C4, and C5.

C3, C4, and C5.

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

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

Pneumothorax is defined as: A. blood collection within the pleural space. B. accumulation of air in the pleural space. C. blood collection within the lung tissue. D. accumulation of air between the lungs.

accumulation of air in the pleural space.

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

administer oxygen and transport to the hospital.

Patients with rib fractures will commonly: A. breathe rapidly and shallowly. B. prefer to lie in a supine position. C. take a series of deep breaths. D. develop a sucking chest wound.

breathe rapidly and shallowly.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT: A. collapsed jugular veins. B. unilaterally absent breath sounds. C. profound cyanosis. D. bulging intercostal muscles.

collapsed jugular veins.

The thoracic cavity is separated from the abdominal cavity by the: A. diaphragm. B. anterior rib cage. C. costovertebral angle. D. intercostal margin.

diaphragm.

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. diminished breath sounds B. widening pulse pressure C. a rapid, irregular pulse D. engorged jugular veins

engorged jugular veins.

Common signs and symptoms of a chest injury include all of the following, EXCEPT: A. localized pain. B. hematemesis. C. tachypnea. D. chest wall ecchymosis.

hematemesis.

The MOST critical treatment for a tension pneumothorax involves: A. placing a bulky dressing over the affected side of the chest. B. surgically removing the portion of the lung that is damaged. C. assisting the patient's breathing with increased tidal volume. D. inserting a needle through the rib cage into the pleural space.

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

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged: A. minute volume will increase. B. minute volume will decrease. C. minute volume will remain unchanged. D. excess carbon dioxide will be eliminated.

minute volume will decrease.

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.

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

A spinal cord injury at the level of C7 would MOST likely result in: A. paralysis of the diaphragm. B. paralysis of the intercostal muscles. C. immediate cardiac arrest. D. paralysis of all the respiratory muscles.

paralysis of the intercostal muscles.

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called: A. dyspnea. B. pleurisy. C. pneumonitis. D. pneumothorax.

pleurisy.

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 applying 100% oxygen, you should: A. apply bulky dressings to the sternum. B. prepare for immediate transport. C. determine if he has cardiac problems. D. apply an automated external defibrillator (AED) and take his blood pressure.

prepare for immediate transport.

During your 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: A. make note of it and continue your assessment. B. stabilize the chest wall with a bulky dressing. C. reassess the adequacy of the patient's breathing. D. request a paramedic to decompress the chest.

stabilize the chest wall with a bulky dressing.

Very young children tend to breathe predominantly with their diaphragm because: A. their chest wall and ribs are very pliable. B. there is no nerve innervation of the intercostal muscles. C. their intercostal muscles are not fully developed. D. they require less tidal volume per breath.

their intercostal muscles are not fully developed.

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of: A. a massive cardiac contusion. B. traumatic aortic rupture. C. penetrating lung injuries. D. a tension pneumothorax.

traumatic aortic rupture.

Pleural fluid is contained between the: A. visceral and parietal pleurae. B. parietal pleura and the chest wall. C. parietal pleura and the heart. D. visceral pleura and the lung.

visceral and parietal pleurae.