EMT Chapter 29 (Block 6)

Which of the following is most likely to cause immediate death? Select one: A. Aortic rupture B. Pulmonary contusion C. Aortic dissection D. Myocardial contusion

A. Aortic rupture

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

A. C3, C4, and C5.

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

A. 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. laceration of the aorta. B. pericardial tamponade. C. massive hemothorax. D. tension pneumothorax. Feedback

A. laceration of the aorta.

A spinal cord injury at the level of C7 would MOST likely result in: Select one: A. paralysis of the intercostal muscles. B. paralysis of all the respiratory muscles. C. paralysis of the diaphragm. D. immediate cardiac arrest.

A. paralysis of the intercostal muscles.

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: Select one: A. prepare for immediate transport. B. apply bulky dressings to the sternum. C. determine if he has cardiac problems. D. apply an AED and assess his BP.

A. prepare for immediate transport.

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: Select one: A. pulmonary contusion. B. traumatic asphyxia. C. tension pneumothorax. D. massive hemothorax.

A. pulmonary 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: Select one: A. rib fractures. B. a pneumothorax. C. a pulmonary contusion. D. a sternal fracture.

A. rib fractures.

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

A. the intercostal muscles contract.

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

B. Lungs

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

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

Closed chest injuries are typically caused by _______. Select one: A. flying debris B. blunt trauma C. penetrating trauma D. high-velocity weapons

B. blunt trauma

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

B. immediately request ALS support.

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she: Select one: A. will eliminate more carbon dioxide than if he or she were breathing deeply. B. must increase his or her respiratory rate to maintain adequate minute volume. C. will maintain adequate minute volume if his or her respiratory rate stays the same. D. 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.

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: Select one: A. cardiac tamponade. B. pneumothorax. C. flail chest. D. myocardial contusion.

B. pneumothorax.

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

B. visceral and parietal pleurae.

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

C. 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: Select one: A. recognize that he needs a needle decompression. B. circumferentially tape a dressing around his chest. C. administer oxygen and transport to the hospital. D. immediately perform a rapid head-to-toe exam.

C. administer oxygen and transport to the hospital.

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

C. air enters the pleural space from outside the body.

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: Select one: A. make note of it and continue your assessment. B. apply high-flow oxygen via nonrebreathing mask. C. assist ventilations with a bag-valve mask. D. request a paramedic to decompress the chest.

C. assist ventilations with a bag-valve mask.

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: Select one: A. pneumothorax. B. traumatic asphyxia. C. commotio cordis. D. cardiac tamponade.

C. commotio cordis.

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

C. 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: Select one: A. call for a paramedic ambulance. B. begin rapid transport at once. C. partially remove the dressing. D. begin ventilatory assistance.

C. partially remove the dressing.

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

C. phrenic

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

C. requires prompt ventilation and oxygenation.

Patients with chest injuries will often present with _______. Select one: A. agonal respirations B. Kussmaul respirations C. tachypnea D. Cheyne-Stokes respirations

C. tachypnea

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

C. their intercostal muscles are not developed

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

D. Clear and equal breath sounds

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

D. No heart murmurs

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

D. The pressure inside the chest increases.

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

D. aggressively manage his airway.

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

D. diaphragm.

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. Select one: A. tension pneumothorax B. hemopneumothorax C. hemothorax D. pneumothorax

D. pneumothorax

Immediately life-threatening chest injuries must be found and managed during the _______. Select one: A. scene size-up B. patient history C. secondary assessment D. primary assessment

D. primary assessment

major artery in the chest

aorta

The trachea divides into the right and left main stem_____

bronchi

During inhalation, the pressure in the chest _______

decreases

Chest falls

exhalation

Chest rises

inhalation

Center cavity of the thorax

mediastinum

The ____ lines the inner chest wall.

parietal pleura

Sac around the heart

pericardium

Chest

thoracic cage