Chapter 29 Chest Injuries

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:

administer oxygen and transport to the hospital

An open pneumothorax occurs when:

air enters the pleural space from outside the body

Major artery in the chest

Aorta

Which of the following is most likely to cause immediate death?

Aortic rupture

The phrenic nerves control the diaphragm and exit the spinal cord at:

C3, C4, and C5

Which of the following is NOT a sign or symptom of a chest injury?

Clear and equal breath sounds

Chest rises

Inhalation

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?

Engorged juglar veins

Chest falls

Exhalation

Which of the following organs or structures does NOT reside within the mediastinum?

Lungs

Center cavity of the thorax

Mediastinum

Which of the following is NOT a pertinent negative to note during your assessment of a patient with chest trauma?

No heart murmurs

Sac around the heart

Pericardium

On inhalation, which of the following does NOT occur?

The pressure inside the chest increases

Chest

Thoracic cage

A flail chest occurs when:

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

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:

aggressively manage his airway

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:

assist ventilations with a bag-valve mask

Closed chest injuries are typically caused by ___.

blunt trauma

The trachea divides into the right and left main stem ___.

bronchi

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:

commotio cordis

A simple pneumothorax:

is commonly caused by blunt chest trauma

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:

laceration of the aorta

When a person is lying supine at the end of exhalation, the diaphragm:

may rise as high as the nipple line

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

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:

paralysis of the intercostal muscles

The ___ lines the inner chest wall.

parietal pleura

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:

partially remove the dressing

The ___ nerves control the diaphragm.

phrenic

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.

pneumothorax

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:

pneumothorax

Immediately life threatening chest injuries must be found and managed during the ___.

primary assessment

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:

pulmonary contusion

A patient who presents with profound cyanosis following a chest injury:

requires prompt ventilation and oxygenation

Patients with chest injuries will often present with ___.

tachypnea

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract

Children are often "belly breathers" because ___.

their intercostal muscles are not developed

The thoracic cavity is separated from the abdominal cavity by the:

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 distension, and unilaterally absent breath sounds. As you partner is supporting her ventilations, you should:

immediately request ALS support

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:

prepare for immediate transport

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:

rib fractures

Pleural fluid is contained between the:

visceral and parietal pleurae