About what percentage of vehicle deaths are attributable to thoracic injuries?
pg 189
25%
Which of the following is located within the thorax?
The heart
The trachea
Both lungs
The esophagus
All of the above
pg 189
All of the above
How many floating rib pairs are there?
pg 190
Two
List the lines is used to describe position on the chest wall?
pg 190
Posterior axillary line
Midclavicular line
Anterior axillary line
Medial axillary line
How high does the diaphragm rise in the chest during a maximum expiration?
pg 190
To the 6th intercostal space posteriorly
The muscle(s) of respiration responsible for reducing the distance between ribs and helping lift the thorax is (are) the
pg 190
intercostal muscles.
The structure that separates the chest cavity from the abdominal cavity is the
pg 190
diaphragm.
At the beginning of and during most of expiration, the pressure within the thorax is
pg 190
more than the atmospheric pressure.
Which structure(s) enter(s) or exit(s) the lungs at the pulmonary hilum?
pg 190
Right mainstem bronchus
Pulmonary artery
Pulmonary veins
T/F - The right lung has only two lobes because the heart’s greatest mass is on the right.
pg 190
False
The serous structure that ensures the lungs expand with the thoracic cage wall and diaphragm is the
pg 190
pleura.
Which of the following act(s) as a shut-off switch for respiration?
pg 191
The apneustic center
Which of the following structures is NOT located within the mediastinum?
Thoracic duct
Vagus nerve
Phrenic nerve
Esophagus
Pulmonary hilum
pg 191
Pulmonary hilum
Which of the following statements is NOT true regarding the pericardium?
A. The pericardial fluid is straw colored.
B. The pericardial fluid acts as a lubricant.
C. The pericardium normally contains no more than 5 mL of fluid.
D. The epicardium and visceral pericardium are one and the same.
E. The fibrous pericardium is not the parietal pericardium.
pg 191
The pericardium normally contains no more than 5 mL of fluid.
The outer layer of the heart is the
pg 191
epicardium.
The intercostal arteries and nerves run
pg 191
below the ribs.
Which of the following is NOT likely to be associated with blunt trauma?
pg 192
Pericardial tamponade
Which of the following is NOT likely to be associated with penetrating trauma?
pg 192
Traumatic asphyxia.
Rib fracture is found in about what percent of significant chest trauma?
pg 194
50 percent
Which ribs are fractured the most frequently
pg 194
4 through 8
Which rib group, when fractured, is most frequently associated with aortic rupture?
pg 194
Ribs 1 and 3
Which of the following groups is more likely to experience internal injury without rib fracture?
pg 195
Pediatric patients
Which of the following are associated with a rib fracture?
Local pain
Hemothorax
Crepitus
Limited chest excursion
All of the above
pg 195
All of the above
Which of the following is most frequently associated with sternal fracture?
Hemothorax
Simple pneumothorax
Blunt cardiac injury
Open pneumothorax
Esophageal injury
195
Blunt cardiac injury
Air from under the flail segment in flail chest does which of the following?
Moves out from under the segment during expiration
Moves toward the mediastinum during expiration
Does not move with the segment
Moves out from under the segment during inspiration
None of the above
pg 196
Moves out from under the segment during inspiration
As the pain of the flail chest increases with time, the amount of paradoxical movement will
decrease due to muscular splinting.
pg 196
False
Simple pneumothorax is associated with what percent of serious thoracic trauma?
pg 197
15 - 50%
The condition in which a part of the chest wall moves in opposition to the rest of the chest due
to numerous rib fractures is called
pg 195
Flail Chest
The chest injury that causes the patient to experience increasing dyspnea because of an open or
closed pneumothorax that has a valve-like function and allows intrathoracic pressure to
increase is referred to as
pg 198
tension pneumothorax
For a significant amount of air to move through an open wound to create an open
pneumothorax, the wound opening must be
pg 197
two-thirds the size of the tracheal opening.
What is a very late sign of tension pneumothorax?
pg 198
Tracheal deviation away from the injury
Each hemithorax can hold up to what volume of blood from a hemothorax?
pg 199
3,000 mL
Which of the following statements is NOT true regarding hemothorax?
Hemorrhage into the thorax is more severe due to decreased pressure there.
Serious hemothorax may displace an entire lung and has a 75 percent mortality rate.
Hemothorax often occurs with pneumothorax.
Hemothorax rarely occurs with simple rib fractures.
None of the above.
pg 199
Hemothorax rarely occurs with simple rib fractures.
Distant or absent breath sounds heard during auscultation of the chest and the signs of shock
are suggestive of which pathology?
pg 199
Hemothorax
Which of the following problems would most likely result in a chest area that is dull to percussion?
pg 199
Hemothorax
Your patient has received chest trauma yet did not initially present with crackles. However, as
the assessment continues, they are heard in both the lower lung fields. This condition is most
likely a result of which of the following?
pg 200
Pulmonary contusion
T/F - Extensive pulmonary contusions may account for blood losses up to 1,500 mL.
pg 200
True
The most common cause of blunt cardiac injury is
pg 200
blunt anterior chest trauma.
A patient presents with the signs of shock, jugular vein distention, distant heart sounds, and a
narrowing pulse pressure. The lung fields are clear. Which condition is most likely the cause?
pg 200
Pericardial tamponade
Pericardial tamponade occurs with what frequency in serious chest trauma patients
pg 201
Less than 2 percent of the time
What are signs of pericardial tamponade?
pg 202
Pulsus paradoxus
Hypotension
A narrowing pulse pressure
Distended jugular veins
A decrease in jugular vein distention during inspiration is known as
pg 202
Kussmaul’s sign.
A blood pressure drop of more than 10 mmHg with inspiration is known as
pg 202
pulsus paradoxus.
T/F - If the chamber of the heart is significantly damaged yet does not rupture immediately, it is
likely to rupture in around two weeks.
pg 202
True
Your patient was involved in a lateral-impact auto collision. The car is greatly deformed,
though the patient does not have many signs of injury. During your assessment, he complains
of a tearing sensation in his central chest and numbness in his left upper extremity. Your
highest index of suspicion of injury is for
pg 203
Aortic dissection
What percentage of patients with traumatic aortic dissection will survive the initial impact and
injury?
pg 202
As high as 20 percent
In a patient with a history of blunt lateral trauma and a suspected traumatic aortic dissection,
which signs or symptoms would you expect to find?
pg 203
Severe, tearing chest pain
Pulse deficit between extremities
Reduced pulse strength in the lower extremities
Hypertension
A harsh systolic murmur is heard over the central chest. This is suggestive of which pathology?
pg 203
Traumatic aortic dissection
T/F - The right side is the site of most diaphragmatic ruptures because most assailants are
right-handed.
pg 203
False
The traumatic diaphragmatic rupture is likely to present like which of the following thoracic injuries?
pg 204
Tension pneumothorax
The two major problems associated with traumatic asphyxia are restriction of chest excursion and
pg 204
restriction of venous return.
The classic signs of traumatic asphyxia are?
pg 204
Bulging eyes
Conjunctival hemorrhage
Petechiae of the head and neck
Dark red or purple appearance of the head and neck
Serious penetrating trauma will likely require what Standard Precaution procedures?
pg 205
Gloves
Mask
Face shield
Gown
During your assessment of a supine patient with blunt chest trauma, you notice slight jugular
vein distention. With no other signs of injury, this suggests which of the following?
pg 206
A normal patient
Crackles heard during auscultation of the chest are suggestive of which pathology?
pg 206
Pulmonary contusion
Hyperresonance heard during percussion of the chest is suggestive of which pathology?
pg 207
Tension pneumothorax
&
pneumothorax
Which of the following thoracic structures takes the least energy to fracture and often results
as a more common, yet less serious, thoracic injury?
pg 207
Ribs 4 through 8
A patient who displays subcutaneous emphysema is most likely to have which of the following
conditions?
pg 207
Tension pneumothorax
T/F - Overdrive ventilation (bag-valve masking) of the patient with flail chest will cause the flail
segment to move with, rather than in opposition to, the chest wall.
pg 209
True
Which of the following is an indication for the use of IV infusion?
A. Diaphragmatic rupture
B. Penetrating chest injury
C. Chest trauma with a blood pressure below 80
D. Chest trauma with a blood pressure below 50
E. Suspected pericardial tamponade
pg 209
C. Chest trauma with a blood pressure below 80
T/F - Meperidine, diazepam, or morphine may be given to the minor rib fracture patient to reduce
pain and increase respiratory excursion.
pg 209
True
The patient who is suspected of a flail chest or other thoracic cage injury, without suspected
spine injury, should be positioned
pg 209
on the injured side.
The open pneumothorax should be cared for using which of the following techniques?
A. Pack the wound with a sterile dressing.
B. Cover the wound with an occlusive dressing and tape securely.
C. Cover the wound with an occlusive dressing, taped on three sides.
D. Attempt to close the wound with a hemostat and then cover with a sterile dressing.
E. Cover the wound loosely with a sterile dressing.
pg 210
C. Cover the wound with an occlusive dressing, taped on three sides.
Which location is recommended for prehospital pleural decompression?
pg 210
2nd intercostal space, midclavicular line
A few minutes after you have inserted a needle and decompressed a tension pneumothorax,
you notice that a patient’s dyspnea is getting worse and breath sounds on the injured side are
becoming diminished. Which action would you take?
pg 210
Insert a second needle.
A patient is trapped in a wrecked auto for about half an hour and is suspected of having
traumatic asphyxia. Care should include?
pg 212
Two large-bore IVs
Normal saline or lactated Ringer’s solution
Fluids run rapidly
Consideration of sodium bicarbonate