Deck 34: Chest Trauma

Question 1

You are managing a patient with a large flail segment to the right lateral chest. As such, you should recognize that the immediate threat to life is:

A) blood loss.
B) hypoxia.
C) infection.
D) rib fractures.

Answer 1

B

Question 2

A patient has sustained an injury to his mediastinum. Based on the anatomy of his chest, which one of the following structures has been injured?

A) Diaphragm
B) Esophagus
C) Lungs
D) Bronchus

Answer 2

B

Question 3

You have applied a nonporous dressing to a stab wound on a patient's chest. The Emergency Medical Responder assisting you asks you why the dressing was taped on three sides and not all four. Your best response is that taping the dressing on three sides:

A) permits oxygen to still enter the lungs.
B) allows trapped air to escape on exhalation.
C) causes less pain for the patient.
D) decreases the chance of air entering the chest on exhalation.

Answer 3

B

Question 4

During the secondary assessment, the EMT notes instability and a flail segment to a patient's lower left lateral chest. The EMT would immediately:

A) auscultate breath sounds.
B) stabilize the segment with his hand.
C) start positive pressure ventilation.
D) apply bulky dressings to the area.

Question 5

When assessing a patient who sustained blunt trauma to the chest, what assessment finding is most indicative of an injury to the lung?

A) Ability to speak a few words and then gasp
B) Elevated heart rate and blood pressure
C) Respiratory rate of 20 breaths per minute
D) Extensive bruising to the anterior chest

Question 6

A patient with blunt chest wall trauma has a flail section to her chest. She is conscious and confused and breathing rapidly and shallowly. After manually stabilizing the flail section of the chest wall, the EMT best treats this condition by:

A) applying ice packs to the flail segment.
B) administering oxygen through a nonrebreather face mask.
C) providing positive pressure ventilation.
D) inserting an oropharyngeal airway.

Question 7

You are on the scene of a shooting. Your assessment reveals a 23-year-old male who has been shot twice. The first wound is to the left lower quadrant of the abdomen and is actively bleeding. The second wound is to the left lateral chest and bubbles every time the patient takes a breath. Your immediate action would be:

A) obtain a sterile dressing and cover the chest wound.
B) cover the chest wound with a gloved hand.
C) place direct pressure over the abdominal gunshot wound.
D) place the patient on high-concentration oxygen with a nonrebreather face mask.

Question 8

A paramedic has asked that you apply a dressing over a sucking chest wound. What is best to cover the injury?

A) Dry sterile gauze dressing
B) Sterile gauze soaked in sterile water
C) Clean washcloth
D) Vaseline gauze

Question 9

A 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and he is complaining of shortness of breath. When he speaks he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which one of the following should you do first?

A) Suction the blood from the airway.
B) Provide positive pressure ventilation.
C) Stabilize the knife with bulky dressings.
D) Remove the knife and seal the injury with a dressing.

Question 10

A 39-year-old male has a single stab wound to the anterior chest. When notifying the emergency department, you inform them that the patient is suffering from a/an:

A) flail chest.
B) evisceration.
C) laceration.
D) open chest injury.

Question 11

A construction foreman was stabbed with a screwdriver in the right anterior chest by an angry employee. Prior to your arrival, he removed the screwdriver. He is alert and oriented and complaining of pain to the injury site. Your primary assessment reveals an open airway, adequate breathing, and strong radial pulse. Based on these findings, which of the following would be done first?

A) open the airway using the jaw-thrust maneuver.
B) take manual in-line spinal stabilization.
C) evaluate the patient SpO₂ level.
D) insert a nasopharyngeal airway.

Question 12

An Emergency Medical Responder asks you to explain a pneumothorax. You would explain that a pneumothorax occurs when:

A) the lung becomes overinflated with air and collapses.
B) air accumulates around the lung, causing a portion of it to collapse.
C) the trachea becomes obstructed, causing the lungs to collapse.
D) air enters the lung and alveoli from a traumatic opening in the chest wall.

Question 13

A patient has been shot in the chest with a rifle. Assessment reveals a deteriorating level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and the entrance wound, located midclavicular at the second intercostal space on the left side of the chest, has been covered. Your next action would be to:

A) check the blood pressure.
B) place a cervical collar.
C) look for an exit wound.
D) get a full set of vital signs.

Question 14

A 23-year-old female has been involved in a serious motor vehicle collision. Which assessment finding best indicates that she has a flail segment?

A) Paradoxical chest wall movement
B) Shortness of breath
C) Intense pain with inspiration
D) Decreasing SpO₂ reading

Question 15

Which of the following best describes a flail segment?

A) Multiple rib fractures that have bruised the underlying lung
B) Fractured ribs that have collapsed the underlying lung
C) Multiple fractures to the rib cage caused by blunt trauma
D) Two or more adjacent ribs broken in two or more places

Question 16

When assessing a patient, which sign or symptom is most indicative of a pneumothorax?

A) SpO₂ of 90% on high-concentration oxygen
B) Intense pain with each inspiration
C) Decreased breath sounds to the right lung
D) Crepitus and instability to the chest wall

Question 17

An adult female is found unresponsive after being shot in the chest. Which statement made by your partner is of most concern?

A) "I see an entry wound but cannot find the exit anywhere."
B) "Her SpO₂ has gone from 90% to 93%."
C) "I do not think her jugular veins are distended."
D) "She is getting more difficult to ventilate."

Question 18

A confused 62-year-old female fell at home, hitting the side of a table with her chest. Assessment reveals instability to the left lateral chest accompanied by minor bruising in the same area. She complains of intense pain every time she breathes. Her airway is patent, breathing is rapid and shallow, and skin warm and nondiaphoretic. Vital signs are pulse 112, respirations 24, and blood pressure 132/64 mmHg with SpO₂ at 90%. Breath sounds are shallow but equal to both lungs. Based on those findings, you should treat this patient for what life-threatening condition?

A) Shock
B) Pain
C) Pneumothorax
D) Hypoxia

Question 19

Which statement made by an EMT demonstrates an understanding of chest trauma?

A) "Open chest injuries are more serious than closed chest injuries, because air and bacteria can enter the chest through the open wound."
B) "In general, an open chest injury caused by blunt trauma is more life threatening than a closed one due to increased potential for blood loss."
C) "Closed chest injuries are caused by blunt trauma, and can be just as serious as open chest injuries."
D) "Closed chest injuries are caused by penetrating trauma and cause more life-threatening injuries than do open chest injuries."

Question 20

An unrestrained 32-year-old female motorist hit a utility pole head on at 45 mph. The car sustained extensive damage. She has an open airway, breathing poorly at 32 breaths per minute, and is responsive to painful stimuli. The radial pulse is rapid and weak, and her skin is cool and cyanotic. Breath sounds are decreased on the right side. Emergency Medical Responders are maintaining manual in-line stabilization. Your next action would be to:

A) start positive pressure ventilation.
B) examine the patient for additional injuries.
C) place a cervical collar and immobilize her.
D) palpate the chest wall for instability.

Question 21

The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes what statement?

A) "A tension pneumothorax causes blood to accumulate around the lung; a pneumothorax involves the accumulation of only air around the lung."
B) "A tension pneumothorax causes cardiac output to decrease; a simple pneumothorax does not affect cardiac output."
C) "A pneumothorax describes a collapsed lung; a tension pneumothorax involves both a collapsed lung and blood loss."
D) "A pneumothorax is caused by a closed chest injury; a tension pneumothorax is caused by an open chest injury."

Question 22

Assessment findings of a patient ejected from a motorcycle indicate that he has a flail chest wall segment to his right anterior chest. He exhibits labored breathing and an SpO₂ at 94%. Breath sounds are clear and equal bilaterally. The segment has been stabilized, and you are prepared to start positive pressure ventilation. Given these assessment findings, what type of injury underlying the flail segment is your primary concern?

A) Pulmonary contusion
B) Pneumothorax
C) Hemothorax
D) Rib fractures

Question 23

A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary assessment, which of the following signs and/or symptoms would concern you that she is suffering from a tension pneumothorax?

A) Absent breath sounds on the right, distended neck veins, tracheal deviation to the left
B) Absent breath sounds on the left, hypotension, SpO₂ at 98%, bradycardia
C) Respiratory distress, absent breath sounds on the left, flat neck veins, tachycardia
D) Absent breath sounds on the right, tracheal deviation to the right, cyanosis

Question 24

A patient has been involved in a motorcycle crash and has a flail segment to the right lateral chest. His airway is open and he is breathing poorly at 24 breaths per minute with a decreasing SpO₂. The EMT shows that he is appropriately caring for this injury when he:

A) administers oxygen through a nonrebreather face mask.
B) positions the patient in a semi-Fowler's position for transport.
C) places an ice pack over the site of injury.
D) starts positive pressure ventilation.

Question 25

The EMT's primary and first concern with any open injury to the chest is:

A) controlling internal bleeding.
B) evaluating for crepitus.
C) stopping air entry.
D) checking for intercostal muscle damage.

Question 26

Assessment findings on a 33-year-old female who has been shot in the right side of the chest indicate that she is suffering from a pneumothorax. As you care for this patient, your primary concern is monitoring the injury for:

A) arterial bleeding.
B) infection at the wound site.
C) tension pneumothorax.
D) sucking sound at the wound site.

Question 27

On scene at a college football game, a wide receiver is unresponsive after colliding with another player and forcefully taking a helmet to the chest. The athletic trainer reports that the patient is pulselesss and apneic. Given the mechanism of injury and patient's presentation, which instruction would be appropriate?

A) "Let's apply the AED and follow all prompts."
B) "Before we do anything, we need to immobilize him."
C) "Use the AED but no CPR so we do not worsen the potential chest injury."
D) "Someone start positive pressure ventilation while I check for a blood pressure."

Question 28

You are transporting a young and healthy female patient who was involved in a motor vehicle collision and struck her chest on the steering column. Although the primary assessment reveals no life threats, she does have redness to her sternum, as well as pain and tenderness. Breath sounds are clear and present bilaterally and vital signs are within normal limits. As you transport and reassess her, what sign or symptom would be most concerning?

A) Increased tenderness over sternum
B) New complaint of leg pain
C) Development of bruise over sternum
D) Onset of an irregular heartbeat

Question 29

An unrestrained female driver hit a utility pole at a moderate rate of speed and struck the steering wheel with her chest. Her airway is open, and she states that it is painful to breathe. Her pulse is moderate in strength and irregular. Breath sounds are equal bilaterally, and there is no jugular venous distention noted. Assessment of her chest reveals bruising and instability to the sternum. When asked, she denies any past medical history. Based on this mechanism and assessment findings, the EMT should be suspicious for what condition?

A) Pneumothorax
B) Traumatic asphyxia
C) Tension pneumothorax
D) Cardiac contusion

Question 30

A middle-aged male has been stabbed once in the left anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear and equal bilaterally. The vital signs are: pulse 140, respirations 24, blood pressure 100/78 mmHg, and SpO₂ 96% on supplemental oxygen. Given this presentation, you would have a high index of suspicion for:

A) pneumothorax.
B) hemothorax.
C) flail segment.
D) pericardial tamponade.

Question 31

You suspect that a patient with an open pneumothorax may be developing a tension pneumothorax. What action is critical given this situation?

A) Remove the occlusive dressing.
B) Lift one side of the dressing during expiration.
C) Gently apply pressure to the chest during inspiration.
D) Ensure that all four sides of the dressing are taped.

Question 32

On scene, a paramedic directs you to help another EMS crew with a patient who was hit by a passenger van that ran into a crowd. As you approach the patient, what scene size-up clue seemingly indicates that the patient is suffering from traumatic asphyxia?

A) Wound to the chest making a sucking sound
B) Abdominal bruising and distention
C) Bluish discoloration to the neck and face
D) Bilateral femur deformity

Question 33

An alert and oriented young male fell 5 feet from a stage, impacting a metal railing with the right side of his chest, just under his armpit. The primary assessment is negative for life threats, although he does complain of very painful breathing and has remarkable tenderness and crepitus over the 5th rib laterally in this area. Throughout care, what action is essential to perform?

A) Apply ice to area.
B) Administer aspirin for pain.
C) Monitor breath sounds.
D) Splint site with a bulky dressing.

Question 34

You have been called to a New Year's party for a male patient who was stabbed in the anterior chest. According to partygoers, the patient went outside with another male and was stabbed. Fifteen minutes later, he was found in the snow and 911 was called. When assessing this patient, what finding would you consider most serious and warrant immediate attention?

A) Complaint of a worsening headache
B) Capillary refill of 3 seconds
C) Decreased breath sounds to the left lung
D) Pain and bruising to the left thigh

Question 35

You suspect a trauma patient to be suffering from a hemothorax to the left lung. What assessment finding would reinforce this suspicion?

A) Neck vein distention and absent breath sounds to the right lung
B) Cyanosis and a blood pressure of 210/100 mmHg
C) Bradycardia and hypertension
D) Respiratory distress and the signs and symptoms of shock

Question 36

A young boy has an open chest wound to the left lateral area after falling off of his bike onto a metal spike in the ground. His family is present and very upset and crying. As an EMT, you recognize that in this situation, your primary focus is:

A) controlling pain.
B) maintaining oxygenation.
C) providing emotional support.
D) preventing potential wound infection.

Question 37

Damage to tissues of what thoracic structure(s) will cause impairment of ventilation and a pneumothorax?

A) Mediastinum
B) Pleural membranes
C) Trachea
D) Pulmonary arteries

Question 38

Care for an open chest wound and an abdominal evisceration are similar in that:

A) air must be periodically released from both wounds.
B) occlusive dressings are placed over both wounds.
C) moist dressings are placed over both wounds.
D) both wounds can cause the trapping of air in the body.

Question 39

You are transporting a 19-year-old male with a gunshot wound to the chest. On scene you covered the wound with an appropriate dressing. Now, as you reassess the patient, you note that the patient is tachypneic and complaining of difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be to:

A) tape the dressing on the fourth side.
B) lift the dressing from the wound for several seconds.
C) provide positive pressure ventilation with high-concentration oxygen.
D) cover the wound with another dressing.

Question 40

A young male patient is self-extricated after hitting a telephone pole and rolling his car several times at a high rate of speed. He is spitting blood and has a large area of tenderness and instability to the left side of his chest. On scene you did not observe any paradoxical motion of the chest wall. The patient remains alert and oriented with stable vital signs, but continually complains of painful breathing. During transport, what is it essential that you do?

A) Reassess for paradoxical motion of the chest wall
B) Apply bulky dressings to the area of chest injury
C) Start positive pressure ventilation with supplemental oxygen
D) Place a nonporous dressing and ice packs to the injured area

Question 41

What mechanism of injury produces the conditions for traumatic asphyxia?

A) Fall 20 feet from scaffolding onto a concrete sidewalk
B) Person strangled but not killed in an attempted rape
C) Penetrating chest trauma with a high-powered firearm
D) Person pinned between a truck and wall of a building

Question 42

On follow-up, the ED physician informs you that a patient you transported earlier was found to have a hemothorax. You would understand this is a condition in which:

A) the trachea was torn.
B) fluid and blood collected around the heart.
C) the pleural membranes were punctured by a rib.
D) blood collected in the chest.