Chapter 27 Chest injuries

Which of the following statements regarding hemothorax is correct? A. It can only be treated by a surgeon B. It results from a collection of air in the pleural space C. Breath sounds tend to be equal D. It is not typically associated with shock

A. It can only be treated by a surgeon

Which of the following is NOT a pertinent negative to note during your assessment of a patient with chest trauma? A. No heart murmurs B. No associated shortness of breath C. No rapid breathing D. No areas of deformity

A. No heart murmurs

You respond to an 18 year old man who has been assaulted with a baseball bat. He was hit in the chest. He is unresponsive, apneic, and pulseless. This condition is most likely related to: A. commotio cordis B. cardiac tamponade C. pnumonthorax D. traumatic asphyxia

A. commontio cordis

The ______ separates the thoracic cavity from the abdominal cavity. A. diaphragm B. mediastinum C. xyphoid process D. inferior border of the ribs

A. diaphragm

A spontaneous pnumonthorax would MOST likely occur as the result of: A. exertion of a person with a congenital lung defect B. excessive coughing in a patient with pnumonitis C. blunt or penetrating trauma to the anterior chest wall D. abnormally slow breathing in a patient with pleurisy

A. exertion of a person with congenital lung defect

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

A. hematemesis

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

A. myocardial contusion

A patient with blunt trauma who is holding the lateral side of his chest and has rapid and shallow respirations is most likely suffering from: A. rib fractures B. a sternal fracture C. a pneumothorax D. a pulmonary contusion

A. rib fractures

Distended jugular veins, a narrowing pulse pressure, and muffled heart sounds are seen in which of the following conditions? A. Tension pneumothorax B. Cardiac tamponade C. Traumatic asphyxia D. Commotio cordis

B. Cardiac tamponade

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

B. collapsed jugular veins

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

B. diaphragm

Large blood vessels in the chest that can result in massive hemorrhaging include all of the following EXCEPT: A. the pulmonary arteries B. the femoral arteries C. the aorta D. the four main pulmonary veins

B. the femoral arteries

Air is supplied to the lungs via the: A. esophagus B. trachea C. nares D. oropharnyx

B. trachea

Which of the following is NOT a sign o symptom of a chest injury? A. Bruising of the chest wall B. Crepitus with palpation of the chest C. Clear and equal breath sounds D. Unequal expansion of the chest wall

C. Clear and equal breath sounds

A sucking chest would should be treated with: A. a standard dressing B. taping down the chest C. an occlusive dressing D. a sandbag over the wound

C. an occlusive dressing

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

C. breath rapidly and shallowly

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

C. coughing up blood

Common signs and symptoms of tension pneumomthorax include all of the following EXCEPT: A. increasing respiratory distress B. distended neck veins C. high blood pressure D. tracheal deviation away from the injured site

C. high blood presure

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 you partner is supporting her ventilation's, you should: A. obtain a set of baseline vital signs B. perform a focused secondary exam C. immediately request ALS support D. insert an oropharyngeal airway

C. immediately request ALS support

Traumatic asphyxia: A. is bruising of the lung B. occurs when three or more adjacent ribs fractured in two or more places C. is a sudden, severe compression of the chest D. results from the pericardial sac filling with blood

C. is a sudden, severe compression of the chest

A _____ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms. A. cardiac tamponade B. pulmonary contusion C. myocardial contusion D. traumatic asphyxia

C. myocardial contusion

On inhalation, which of the following does NOT occur? A. the intercostal muscles contract, elevating the rib cage B. the diaphragm contracts C. the pressure inside the chest increases D. air enters through the nose and mouth

C. the pressure inside the chest increases

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

C. traumatic aortic rupture

Paradoxical motion of the chest refers to: A. rib fractures that move with the chest wall during breathing B. one segment of the chest wall moving opposite the remainder of the chest C. unequal expansion of the chest wall D. one segment of the chest wall moving out on inspiration and in on exhalation

C. unequal expansion of the chest wall

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. collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest B. asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta C. ventricular fibrillation when the impact occurred duing a critical portion of the cardiac cycle D. fracture of the sternum that caused a rupture of the myocardium and let to a cardiac dysrhythmia

C. ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

A ____ results when an injury allows air to enter through a hole in the chest wall or the surface of the lung as the patient attempts to breathe, causing the lung on that side to collapse. A. tension pnumonthorax B. hemothorax C. hemopnumonthorax D. pnumonthorax

D, pneumothorax

Which of the following would NOT give you a low pulse oximetry reading? A. Damaged heart B. Decrease in circulating red blood cells from bleeding C. Pulmonary contusion D. Carbon monoxide poisoning

D. Carbon monoxide poisoning

You respond to the local rodeo arena for a bull rider. The scene is safe, and the patient is lying in the middle of the arena unconscious. His airway is open, and he is breathing at 20 breaths/min. His pulse is 128 beats/min and blood pressure is 110/64 mm Hg. There is no obvious bleeding. Bystanders tell you he was thrown into the air and landed on the bull's head. He was not wearing a vest. Which of the following is NOT indicated in blunt trauma to the chest? A. Bruising of the lungs and heart B. Fracture of whole areas of the chest wall C. Damage to the aorta D. Dissection of the carotid arteries

D. Dissection of the carotid arteries

You respond to a motor vehicle collision and fine a 29 year old woman who is complaining of chest pain. Her chest struck the steering wheel. Her airway is open, she is breathing at 24 breaths/min, and she is coughing up blood. Her pulse is 130 beats/min, rapid and weak, her blood pressure is 90/58 mm Hg. You notice cyanosis around the lips and note that her fingers are also blue. When you expose the chest, she tells you it hurts and points to a bruised spot. Which of the following is a symptom? A. Cyanosis around the lips or fingertips B.Rapid, weak pulse C. Hemoptyis D. Pain at the site of injury

D. Pain at the site of injury

You respond to a 20 year old man who was playing basketball and suddenly developed chest pain and respiratory difficulty. He is alert and orients and complaining of chest pain. He is breathing at 24 breaths/min. His pulse is 140 beats/min and blood pressure is 160/90 mm Hg. Upon listening to the chest, you notice diminished breath sounds on the left side. The patient is most likely suffering from a (n) A. spontaneous pneumothorax B. hemothorax C. tension pnumonthorax D. open pnumonthorax

D. open pnumothorax