Chapter 29

A 28 y/o 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. prepare for immediate transport B. determine if he has cardiac problems C. apply an AED and assess his BP D. apply bulky dressings to the sternum

A. prepare for immediate transport

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

A. the intercostal muscles contract

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

B. assist ventilations with a bag-valve mask

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

B. may rise as high as the nipple line

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. being rapid transport at once

B. partially remove the dressing

Children are often "belly breathers" because ___________- A. they are consciously controlling ventilations B. their intercostal muscles are not developed C. they are routinely hypoxic D. their diaphragm is not functional

B. their intercostal muscles are not developed

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

B. visceral and parietal pleurae

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

C. C3, C4 and C5

A flail chest occurs when: A. more than 3 ribs are fractured on the same side of the chest B. multiple ribs are fractured on both sides of the thoracic cage C. a segment of the chest wall is detached from the thoracic cage D. a segment of fractured ribs bulges during the inhalation phase

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

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. administer oxygen and transport to the hospital D. circumferentially tape addressing around his chest

C. administer oxygen and transport to the hospital

An open pneumothorax occurs when: A. a fractured rib perforates the tissue of the lung B. air enters the pleural space from a perforated lung C. air enters the pleural space from outside the body D. extreme pleural pressure causes the lung to rupture

C. air enters the pleural space from outside the body

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 minutes volume if his or her respiratory rate stays the same B. often breaths at a slower rate because of lungs damage caused by the injury C. must increase his or her respiratory 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 to maintain adequate minute volume

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. a rapid, irregular pulse C. widening pulse pressure D. engorged jugular veins

D. engorged jugular veins

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

D. immediately request ALS support

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

D. is commonly caused by blunt chest trauma

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

D. requires prompt ventilation and oxygenation

Which of the following is most likely to cause immediate death? myocardial contusion aortic dissection aortic rupture pulmonary contusion

aortic rupture

Closed chest injuries are typically caused by__________- flying debris blunt trauma penetrating trauma high velocity weapons

blunt trauma

The thoracic cavity is separated form the abdominal cavity by the diaphragm intercostal margin anterior rib cage costovertebral angle

diaphragm

Which of the following organs or structures does NOT reside within the mediastinum? esophagus lungs vena cavae trachea

lungs

The _____________ nerves control the diaphragm vagus phrenic costal intercostal

phrenic

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

primary assessment

Patients with injuries will often present with__________ agonal respirations Cheyne-stokes respirations tachypnea kussmaul respirations

tachypnea