Chapter 30 Chest trauma

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

A. Lungs

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

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

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

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

A. aggressively manage his airway.

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

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

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.

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

A. requires prompt ventilation and oxygenation.

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

B. Compression of the aorta and vena cava

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

B. Engorged jugular veins

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:

B. administer oxygen and transport to the hospital.

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

B. diaphragm.

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

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

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

B. pleurisy.

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

C. coughing up blood.

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

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

C. laceration of the aorta.

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

C. might rise as high as the nipple line.

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

C. minute volume will decrease.

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

C. myocardial contusion.

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

C. phrenic

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

D. C3, C4, and C5.

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

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

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

D. breathe rapidly and shallowly.

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

D. signs and symptoms of shock.

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

D. the intercostal muscles contract.