EMT-Chapter 29 (chest trauma)

When assessing a patient, which one of the following signs or symptoms is most indicative of the patient suffering from a pneumothorax? a. SpO2 of 90% on high-flow oxygen b. Severe pain with each inspiration c. Decreased breath sounds to the right lung d. Crepitus to the chest wall

c. Decreased breath sounds to the right lung

Pleural fluid is contained between the: a. parietal pleura and the heart. b. visceral pleura and the lung. c. visceral and parietal pleurae. d. parietal pleura and the chest wall.

c. visceral and parietal pleurae.

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

d. blunt trauma

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? a. Lift the dressing from the wound for several seconds. b. Cover the wound with another dressing. c. Tape the dressing on the fourth side. d. Provide positive pressure ventilation with high-flow oxygen.

a. Lift the dressing from the wound for several seconds.

Which of the following organs or structures does NOT reside within the mediastinum? a. Lungs b. Venacavae c. Trachea d. Esophagus

a. Lungs

During your assessment of a patient with blunt chest trauma, you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should: a. assist ventilations with a bag-valve mask. b. request a paramedic to decompress the chest. c. make note of it and continue your assessment. d. apply high-flow oxygen via nonrebreathing mask.

a. assist ventilations with a bag-valve mask.

The _______________ nerves control the diaphragm. a. phrenic b. intercostal c. costal d. vagus

a. phrenic

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

a. tachypnea

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? a. Ensure that all four sides of the dressing are taped. b. Lift one side of the dressing during expiration. c. Gently apply pressure to the chest during inspiration. d. Remove the occlusive dressing.

b. Lift one side of the dressing during expiration.

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.

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

b. diaphragm.

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

b. immediately request ALS support.

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

b. primary assessment

Elevation of the rib cage during inhalation occurs when: a. intrathoracic pressure decreases. b. the intercostal muscles contract. c. abdominal contents descend. d. the diaphragm descends.

b. the intercostal muscles contract.

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? a. Shock b. Pain c. Hypoxia d. Pneumothorax

c. Hypoxia

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? a. Hemothorax b. Rib fractures c. Pulmonary contusion d. Pneumothorax

c. Pulmonary contusion

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? a. Sterile gauze soaked in sterile water b. Dry sterile gauze dressing c. Vaseline gauze d. Clean washcloth

c. Vaseline gauze

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

A 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.

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

c. partially remove the dressing.

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? a. Absent breath sounds on the left, hypotension, SpO2 at 98%, bradycardia b. Absent breath sounds on the right, tracheal deviation to the right, cyanosis c. Respiratory distress, absent breath sounds on the left, flat neck veins, tachycardia d. Absent breath sounds on the right, distended neck veins, tracheal deviation to the left

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

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

d. Engorged jugular veins

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? a. Bradycardia and hypertension b. Neck vein distention and absent breath sounds to the right lung c. Cyanosis and a blood pressure of 210/100 mmHg d. Respiratory distress and the signs and symptoms of shock

d. Respiratory distress and the signs and symptoms of shock

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

d. administer oxygen and transport to the hospital.

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. suspect a severe hemopneumothorax. b. request a paramedic ambulance. c. perform a secondary assessment. d. aggressively manage his airway.

d. aggressively manage his airway

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: a. decreases the chance of air entering the chest on exhalation. b. instead of four is less painful for the patient. c. instead of four permits oxygen to still enter the lungs. d. allows trapped air to escape on exhalation.

d. allows trapped air to escape on exhalation.

Care for an open chest wound and an abdominal evisceration are similar in that: a. both wounds can cause the trapping of air in the body. b. air must be periodically released from both wounds. c. moist dressings are placed over both wounds. d. occlusive dressings are placed over both wounds.

d. occlusive dressings are placed over both wounds.

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

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

d. prepare for immediate transport.

A patient who presents with profound cyanosis following a chest injury: a. should be placed in Trendelenburg position. b. has most likely experienced a ruptured aorta. c. is most likely experiencing severe blood loss. d. requires prompt ventilation and oxygenation.

d. requires prompt ventilation and oxygenation.