EMT Chapter 34

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 inadequately at 24 breaths per minute. The EMT shows that he is appropriately caring for this injury when he: Select one: a. secures a rolled towel over the fractured ribs. b. places an ice pack over the site of injury. c. positions the patient in a semi-Fowler's position for transport. d. administers oxygen through a nonrebreather face mask.

a.

On scene a paramedic directs you to help another EMS crew with a patient who was hit by a passenger van that ran into a crowd. As you approach the patient, which one of the following scene size-up clues seemingly indicates the patient is suffering from traumatic asphyxia? Select one: a. Bluish discoloration to the neck and face b. Abdominal bruising and distention c. Wound to the chest making a sucking sound d. Bilateral femur deformity

a.

Which one of the following best describes a flail segment? Select one: a. Two or more adjacent ribs broken in two or more places b. Multiple fractures to the rib cage caused by blunt trauma c. Multiple rib fractures that have bruised the underlying lung d. Fractured ribs that have collapsed the underlying lung

a.

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

a.

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

d.

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

d.

A 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and he is complaining 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 one of the following should you do first? Select one: a. Stabilize the knife with bulky dressings. b. Suction the blood from the airway. c. Provide positive pressure ventilation. d. Remove the knife and seal the injury with a dressing.

b.

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

b.

A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused and breathing rapidly and shallowly. After manually stabilizing the flail section of the chest wall, the EMT best treats this condition by: Select one: a. administering oxygen through a nonrebreather face mask. b. providing positive pressure ventilation. c. inserting an oropharyngeal airway. d. applying ice packs to the flail segment.

b.

An unrestrained female driver hit a utility pole at a moderate rate of speed and struck the steering wheel with her chest. Her airway is open, and she states that it is painful to breathe. Her pulse is moderate in strength and irregular. Breath sounds are equal bilaterally, and there is no jugular venous distention noted. Assessment of her chest reveals bruising and instability to the sternum. When asked, she denies any past medical history. Based on this mechanism and assessment findings, the EMT should be suspicious for what condition? Select one: a. Pneumothorax b. Cardiac contusion c. Tension pneumothorax d. Traumatic asphyxia

b.

Your patient was involved in a serious motor-vehicle collision. Which one of the following assessment findings best helps to determine that the patient has a flail segment? Select one: a. Shortness of breath b. Paradoxical chest wall movement c. SpO2 reading lower than 90% d. Pain with inspiration

b.

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? Select one: a. Shock b. Pain c. Hypoxia d. Pneumothorax

c.

A patient has been shot in the chest with a rifle. Your assessment reveals a decreasing level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and you have covered the entrance wound located midclavicular at the second intercostal space on the left side of the chest. Which one of the following should you do next? Select one: a. Place a cervical collar. b. Obtain a blood pressure. c. Look for an exit wound. d. Get a full set of vital signs.

c.

An adult female is found unresponsive after being shot in the chest. Which one of the following EMT statements about this patient is of most concern? Select one: a. "Her SpO2 has gone from 90% to 93%." b. "She does not have any jugular venous distention." c. "She is getting more difficult to ventilate." d. "I see an entry wound but no exit wound anywhere."

c.

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

c.

You have been called to a New Year's party for a male patient who was stabbed in the anterior chest. According to partygoers, the patient went outside with another male and was stabbed. Fifteen minutes later, he was found in the snow and 911 was called. When assessing this patient, which finding should the EMT consider most serious and warrant immediate attention? Select one: a. Capillary refill of three seconds b. Pain and bruising to the left thigh c. Decreased breath sounds to the left lung d. Complaint of a worsening headache

c.

An Emergency Medical Responder asks you to explain a pneumothorax. Your response should be that it occurs when: Select one: a. air enters the lung and alveoli from a traumatic opening in the chest wall. b. the trachea becomes obstructed, causing the lungs to collapse. c. the lung becomes over-inflated with air and collapses. d. air accumulates around the lung, causing a portion of it to collapse.

d.

An unrestrained 32-year-old female motorist hit a utility pole head on at 35 mph. The car sustained extensive damage. She exhibits labored respirations and is responsive to painful stimuli with an open airway. She is breathing shallowly at 32 breaths per minute. The radial pulse is rapid and weak, and her skin is cool and cyanotic. Breath sounds are decreased on the right side. Emergency Medical Responders are maintaining manual in-line stabilization. Your next action should be to: Select one: a. palpate the chest wall for instability. b. perform secondary assessment. c. place a cervical collar and immobilize her. d. start positive pressure ventilation.

d.

Assessment findings on a 33-year-old female who has been shot in the right side of the chest indicate that she is suffering from a pneumothorax. During your reassessment, your primary concern is monitoring the injury for: Select one: a. arterial bleeding. b. sucking sound at the wound site. c. infection at the wound site. d. tension pneumothorax.

d.

When assessing a patient who sustained blunt trauma to the chest, which one of the following assessment findings is most indicative of an injury to the lung? Select one: a. Ecchymotic area to the anterior chest b. Respiratory rate of 20 breaths per minute c. Elevated heart rate and blood pressure d. Ability to speak a few words and then gasp

d.