EMT Chapter 29 -- Chest Injuries

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. more than three ribs are fractured on the same side of the chest. D. a segment of fractured ribs bulges during the inhalation phase.

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

A. administer oxygen and transport to the hospital.

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

A. may rise as high as the nipple line.

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

A. primary assessment

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

A. their intercostal muscles are not developed

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

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

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. laceration of the aorta. C. massive hemothorax. D. tension pneumothorax.

B. laceration of the aorta.

If a patient with a chest injury is only able to inhale 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.

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

B. paralysis of the intercostal muscles.

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

B. partially remove the dressing.

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. myocardial contusion. D. flail chest.

B. pneumothorax.

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

B. prepare for immediate transport.

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

C. Engorged jugular veins

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

C. blunt trauma

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

C. 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 distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should: Select one: A. perform a focused secondary exam. B. insert an oropharyngeal airway. C. immediately request ALS support. D. obtain a set of baseline vital signs.

C. immediately request ALS support.

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

C. is commonly caused by blunt chest trauma.

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. massive hemothorax. B. tension pneumothorax. C. pulmonary contusion. D. traumatic asphyxia.

C. pulmonary contusion.

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

C. tachypnea

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

D. Aortic rupture