EMT Chapter 30 Chest Injuries

When assessing a patient with a hemothorax, you will most likely find: Select one: A. signs and symptoms of shock. B. ipsilateral tracheal deviation. C. distant or muffled heart tones. D. jugular venous engorgement.

A. signs and symptoms of shock

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

B. C3, C4, and C5.

Which of the following organs or structures does not reside within the mediastinum? A. Esophagus B. Vena cavae C. Lungs D. Trachea

C. lungs

When a person is lying supine at the end of exhalation, the diaphragm: Select one: A. descends below the level of the navel. B. contracts and flattens inferiorly. C. is less prone to penetrating trauma. D. might rise as high as the nipple line.

D. might rise as high as the nipple line.

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

D. pleurisy.

Signs and symptoms of a tension pneumothorax include all of the following, except: Select one: A. collapsed jugular veins. B. profound cyanosis. C. unilaterally absent breath sounds. D. altered mental status.

A. collapsed jugular veins

Hemoptysis is defined as: A. coughing up blood. B. abnormal blood clotting. C. vomiting blood. D. blood in the pleural space.

A. coughing up blood

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. Engorged jugular veins B. Widening pulse pressure C. Diminished breath sounds D. A rapid, irregular pulse

A. engorged jugular veins

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

A. hematemesis.

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

A. minute volume will decrease

If a patient with a chest injury only inhales small amounts of air per breath, he or she: A. must increase his or her respiratory rate to maintain adequate minute volume. B. often breathes at a slower rate because of lung damage caused by the injury. C. will maintain adequate minute volume if his or her respiratory rate stays the same. D. will eliminate more carbon dioxide than if he or she were breathing deeply.

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

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

A. their intercostal muscles are not fully developed.

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

A. visceral and parietal pleurae.

An open pneumothorax is: A. extreme pleural pressure that causes the lung to rupture. B. an open chest wound through which air moves during breathing. C. a fractured rib that perforates the tissue of the lung surface. D. the entry of air into the pleural space from a perforated lung.

B. an open chest wound through which air moves during breathing

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. apply high-flow oxygen via nonrebreathing mask. B. assist ventilations with a bag valve mask. C. request a paramedic to decompress the chest. D. make note of it and continue your assessment.

B. assist ventilations with a bag mask

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

B. breathe rapidly and shallowly

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

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: Select one: A. insert an oropharyngeal airway. B. immediately request ALS support. C. obtain a set of baseline vital signs. D. perform a focused secondary exam.

B. immediately request ALS support.

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: Select one: A. pericardial tamponade. B. laceration of the aorta. C. tension pneumothorax. D. massive hemothorax.

B. laceration of the aorta.

A rapid, irregular pulse following blunt trauma to the chest is most suggestive of a: A. pericardial tamponade. B. myocardial contusion. C. ruptured aorta. D. tension pneumothorax

B. myocardial contusion

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. partially remove the dressing. C. begin ventilatory assistance. D. begin rapid transport at once.

B. partially remove the dressing

The ________ nerves supply the diaphragm. A. costal B. phrenic C. vagus D. intercostal

B. phrenic

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: Select one: A. determine if he has cardiac problems. B. prepare for immediate transport. C. apply an AED and assess his BP. D. apply bulky dressings to the sternum.

B. prepare for immediate transport.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, shallow breathing, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should: A. perform a rapid head-to-toe physical assessment. B. provide ventilation assistance with a bag valve mask. C. place her supine and elevate her lower extremities. D. apply 100% oxygen via a nonrebreathing mask.

B. provide ventilaiton assistance with a bag valve mask

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? Select one: A. Blood accumulation in the pleural space B. Hidden bleeding in the thoracic cavity C. Compression of the aorta and vena cava D. A total collapse of the affected lung

C. Compression of the aorta and vena cava

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? Select one: A. Unilaterally absent breath sounds B. Flattening of the jugular veins C. Repeat BP of 90/68 mm Hg D. A pulse that becomes irregular

C. Repeat BP of 90/68 mm Hg

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

C. administer oxygen and transport to the hospital.

Subcutaneous emphysema is an indication that: A. at least half of one lung has completely collapsed. B. blood is slowly accumulating within the tissue of the lung. C. air is escaping into the chest wall from a damaged lung. D. your patient is experiencing a pericardial tamponade.

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

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

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

A spinal cord injury at the level of C7 would most likely result in: Select one: 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.

To avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a: Select one: A. myocardial contusion. B. flail chest. C. pneumothorax. D. cardiac tamponade.

C. pneumothorax.

Elevation of the rib cage during inhalation occurs when: A. intrathoracic pressure decreases. B. the diaphragm descends. C. the intercostal muscles contract. D. abdominal contents descend.

C. the intercostal muscles contract

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

C. traumatic aortic rupture.

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.

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

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

D. accumulation of air in the pleural space.

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

D. aggressively manage his airway

A simple pneumothorax: A. is caused by penetrating chest trauma. B. heals on its own without any treatment. C. often has a nontraumatic cause. D. is commonly caused by blunt chest trauma.

D. is commonlu caused by blunt chest trauma

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: A. traumatic asphyxia. B. tension pneumothorax. C. massive hemothorax. D. pulmonary contusion.

D. pulmonary contusion

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

D. requires prompt ventilation and oxygenation

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? A. Asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta B. Fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia C. Collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest D. Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

D. ventricular fibrillation when the impact occurred during na critical portion of the cardiac cycle