Chapter 30 - Chest Injuries Flashcards

1
Q

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

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.

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2
Q

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 fractured ribs bulges during the inhalation phase.

C. multiple ribs are fractured on both sides of the thoracic cage.

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

A

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

Chapter 29, page 1045

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3
Q

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. traumatic asphyxia.

C. pulmonary contusion.

D. tension pneumothorax.

A

C. pulmonary contusion.

Chapter 29, page 1047

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4
Q

A simple pneumothorax:

Select one:

A. is commonly caused by blunt chest trauma.

B. heals on its own without any treatment.

C. often has a nontraumatic cause.

D. is caused by penetrating chest trauma.

A

A. is commonly caused by blunt chest trauma.

Chapter 29, page 1042

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5
Q

A spinal cord injury at the level of C7 would MOST likely result in:

Select one:

A. paralysis of all the respiratory muscles.

B. paralysis of the diaphragm.

C. immediate cardiac arrest.

D. paralysis of the intercostal muscles.

A

D. paralysis of the intercostal muscles.

Chapter 29, page 1031

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6
Q

An open pneumothorax occurs when:

Select one:

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

B. a fractured rib perforates the tissue of the lung.

C. extreme pleural pressure causes the lung to rupture.

D. air enters the pleural space from a perforated lung.

A

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

Chapter 29, page 1041

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7
Q

Children are often “belly breathers” because _______.

Select one:

A. they are consciously controlling ventilations

B. their diaphragm is not functional

C. their intercostal muscles are not developed

D. they are routinely hypoxic

A

C. their intercostal muscles are not developed

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8
Q

Closed chest injuries are typically caused by _______.

Select one:

A. flying debris

B. high-velocity weapons

C. penetrating trauma

D. blunt trauma

A

D. blunt trauma

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9
Q

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. Widening pulse pressure

C. A rapid, irregular pulse

D. Engorged jugular veins

A

D. Engorged jugular veins

Chapter 29, page 1045

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10
Q

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. will eliminate more carbon dioxide than if he or she were breathing deeply.

C. will maintain adequate minute volume if his or her respiratory rate stays the same.

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

A

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

Chapter 29, page 1034

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11
Q

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

Select one:

A. scene size-up

B. primary assessment

C. secondary assessment

D. patient history

A

B. primary assessment

Chapter 29, page 1037

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12
Q

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. myocardial contusion.

C. flail chest.

D. pneumothorax.

A

D. pneumothorax.

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13
Q

Patients with chest injuries will often present with _______.

Select one:

A. tachypnea

B. agonal respirations

C. Cheyne-Stokes respirations

D. Kussmaul respirations

A

A. tachypnea

Chapter 29, page 1036

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14
Q

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

Select one:

A. diaphragm.

B. costovertebral angle.

C. anterior rib cage.

D. intercostal margin.

A

A. diaphragm.

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15
Q

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. contracts and flattens inferiorly.

D. may rise as high as the nipple line.

A

D. may rise as high as the nipple line.

Chapter 29, page 1031

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16
Q

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

Select one:

A. Aortic rupture

B. Aortic dissection

C. Myocardial contusion

D. Pulmonary contusion

A

A. Aortic rupture

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17
Q

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. administer oxygen and transport to the hospital.

B. circumferentially tape a dressing around his chest.

C. immediately perform a rapid head-to-toe exam.

D. recognize that he needs a needle decompression.

A

A. administer oxygen and transport to the hospital.

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18
Q

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. Y You should be MOST suspicious that this patient has experienced a:

Select one:

A. massive hemothorax.

B. tension pneumothorax.

C. pericardial tamponade.

D. laceration of the aorta.

A

D. laceration of the aorta.

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19
Q

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. partially remove the dressing.

B. begin rapid transport at once.

C. begin ventilatory assistance.

D. call for a paramedic ambulance.

A

A. partially remove the dressing.

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20
Q

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. insert an oropharyngeal airway.

B. obtain a set of baseline vital signs.

C. immediately request ALS support.

D. perform a focused secondary exam.

A

C. immediately request ALS support.

Chapter 29, page 1044

21
Q

Hemoptysis

A

Spitting or coughing up blood

22
Q

Commotio Cordis

A
  1. Direct blow to a critical portion (moment) of the heart
  2. Ventricular Fibrillation responds well to define within the first 2 minutes
23
Q

The treatment for relieving a tension pneumothorax involves:

placing a bulky dressing over the affected side of the chest.

assisting the patient’s breathing with increased tidal volume.

surgically removing the portion of the lung that is damaged.

inserting a needle through the rib cage into the pleural space.

A

inserting a needle through the rib cage into the pleural space.

24
Q

The esophagus, trachea, and great vessels reside in the _______.

mediastinum

posterior thorax

abdominopelvic cavity

retroperitoneal space

A

mediastinum

25
Q

Paradoxical motion is a sign of a _______.

sucking chest wound

flail chest

tension pneumothorax

cardiac tamponade

A

flail chest

26
Q

The pliability of the pediatric rib cage _______.

increases the risk of internal injury

offers greater protection of internal organs

increases the likelihood of rib fractures

reduces the compression of internal organs

A

increases the risk of internal injury

27
Q

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:

pleurisy.

dyspnea.

pneumonitis.

pneumothorax.

A

pleurisy

28
Q

Hemoptysis indicates damage to the _______.

esophagus

lungs

diaphragm

abdomen

A

lungs

29
Q

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

ruptured aorta.

myocardial contusion.

pericardial tamponade.

tension pneumothorax.

A

myocardial contusion

30
Q

Distended jugular veins, narrowing pulse pressure, and muffled heart tones are collectively known as _______.

Cushing triad

Fran-Starling mechanism

Kehr sign

Beck’s triad

A

Beck’s triad

31
Q

When assessing a patient with a hemothorax, you will MOST likely find:

jugular venous engorgement.

ipsilateral tracheal deviation.

distant or muffled heart tones.

signs and symptoms of shock.

A

signs and symptoms of shock

32
Q

If a person’s tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will increase.

minute volume will decrease.

minute volume will remain unchanged.

excess carbon dioxide will be eliminated.

A

minute volume will decrease

33
Q

A patient with a chest injury has a blood pressure of 100/60 mm Hg and a pulse rate of 120 beats/min. Which of the following additional findings should make you suspect a pericardial tamponade?

The pulse becomes irregular

Repeat BP of 90/68 mm Hg

Flattening of the jugular veins

Unilaterally absent breath sounds

A

Repeat BP of 90/68 mm Hg

34
Q

The body’s ability to move air in and out of the lungs is called _______.

respiration

perfusion

ventilation

inspiration

A

ventilation

35
Q

Patients with rib fractures will commonly:

breathe rapidly and shallowly.

take a series of deep breaths.

prefer to lie in a supine position.

develop a sucking chest wound.

A

breathe rapidly and shallowly

36
Q

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred?

Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

Asystole secondary to massive intrathoracic hemorrhage due to traumatic rupture of the aorta

Fracture of the sternum that caused a rupture of the myocardium and led to a cardiac dysrhythmia

Collapse of both lungs due to fractured ribs that perforated the lung tissue and caused cardiac arrest

A

Ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

37
Q

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

a tension pneumothorax.

traumatic aortic rupture.

penetrating lung injuries.

a massive cardiac contusion.

A

traumatic aortic rupture

38
Q

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?

A total collapse of the affected lung

Hidden bleeding in the thoracic cavity

Compression of the aorta and vena cava

Blood accumulation in the pleural space

A

Compression of the aorta and vena cava

39
Q

Pneumothorax is defined as:

accumulation of air between the lungs.

blood collection within the lung tissue.

accumulation of air in the pleural space.

blood collection within the pleural space.

A

accumulation of air in the pleural space.

40
Q

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, shallow breathing, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

apply 100% oxygen via a nonrebreathing mask.

place her supine and elevate her lower extremities.

perform a rapid head-to-toe physical assessment.

provide ventilation assistance with a BVM.

A

provide ventilation assistance with a BVM

41
Q

Common signs and symptoms of a chest injury include all of the following, EXCEPT:

tachypnea.

hematemesis.

localized pain.

chest wall ecchymosis.

A

hematemesis

42
Q

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

profound cyanosis.

collapsed jugular veins.

altered mental status.

unilaterally absent breath sounds.

A

collapsed jugular veins.

43
Q

On inhalation, which of the following does not occur?

The intercostal muscles contract, elevation the rib cage

The diaphragm contracts

Air enters through that the nose and the mouth

The pressure inside the chest increases

A

The pressure inside the chest increases

Chapter 29, page 1033 (The pressure decreases - Boyle’s Law)

44
Q

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:

A. Cardiac Tamponade

B. Commotio Cordis

C. Traumatic Asphyxia

D. Pneumothorax

A

B. Commotio Cordis

Chapter 29, page 1047-1048

45
Q

The _______ lines the inner chest walls.

A

parietal pleura

Chapter 29, page 1032

46
Q

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

C1, C2

C1, C2 & C3

C3, C4

C3, C4 & C5

A

C3, C4 & C5

47
Q

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:

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

A

A. aggressively manage his airway.

48
Q

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

Select one:

A. requires prompt ventilation and oxygenation.
B. has most likely experienced a ruptured aorta.
C. should be placed in Trendelenburg position.
D. is most likely experiencing severe blood loss.

A

A. requires prompt ventilation and oxygenation.

49
Q

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

A

D. assist ventilations with a bag-valve mask.