Question 1

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

Accepted Answer

A pneumothorax involves the accumulation of air around the lung, while a tension pneumothorax is a type of pneumothorax where air continues to enter the pleural space and can cause cardiac output to decrease. Option A is incorrect because a pneumothorax does not involve blood accumulation; option C is also incorrect because both types of pneumothorax involve a collapsed lung, but a tension pneumothorax can lead to blood loss if it is not relieved. Option D is incorrect because both closed and open chest injuries can cause both types of pneumothorax.

Question 2

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?

Accepted Answer

The primary concern underlying the flail segment is a pulmonary contusion. A pulmonary contusion is a bruise to the lung tissue that can occur during a chest injury, such as being ejected from a motorcycle. It can impair gas exchange and cause hypoxemia, as well as lead to further complications. While rib fractures or pneumothorax could also be present, they are secondary concerns to the primary issue of a pulmonary contusion. A hemothorax may also occur with a chest injury, but is not specifically related to the flail segment.

Question 3

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?

Accepted Answer

The signs and symptoms of a tension pneumothorax include absent breath sounds on the affected side, distended neck veins due to increased pressure in the thorax, and tracheal deviation away from the affected side. The patient in this scenario was stabbed in the right anterior chest, so absent breath sounds on the right and tracheal deviation to the left would indicate a tension pneumothorax. Respiratory distress may also occur but is not specific to a tension pneumothorax.

Question 4

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:

Accepted Answer

The patient is breathing poorly with a decreasing SpO2, indicating inadequate oxygenation. Positive pressure ventilation will help improve oxygenation and ventilation. Administering oxygen through a nonrebreather face mask can help, but it may not be sufficient in this case. Positioning the patient in a semi-Fowler's position or placing an ice pack over the site of injury may not be helpful in managing the flail segment or improving the patient's breathing.

Question 5

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

Accepted Answer

The EMT's primary and first concern with any open injury to the chest is to stop air entry. This is because an open chest injury can cause a pneumothorax, a life-threatening condition where air enters the pleural space between the lung and the chest wall, causing the lung to collapse. Controlling internal bleeding and checking for intercostal muscle damage are important considerations, but stopping air entry takes priority in this scenario. Evaluating for crepitus may also be important, but it is not the primary concern with an open chest injury.

Question 6

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:

Accepted Answer

The primary concern for a patient with a pneumothorax is the development of tension pneumothorax. This occurs when a one-way valve is created, allowing air to enter the pleural space during inspiration but not allowing the air to exit during expiration. This causes a buildup of pressure in the pleural space that can compromise the cardiovascular and respiratory systems. Monitoring for signs of tension pneumothorax, such as tracheal deviation, cyanosis, and hypotension, is essential in these cases.

Question 7

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?

Accepted Answer

The patient is pulseless and apneic, indicating cardiac arrest. The appropriate course of action is to immediately initiate cardiopulmonary resuscitation (CPR) and apply the automated external defibrillator (AED) to assess for shockable rhythms. Immobilization is not a priority in this scenario and delaying CPR to check for a blood pressure could be detrimental to the patient's outcome.

Question 8

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?

Accepted Answer

The most concerning sign or symptom would be the onset of an irregular heartbeat, as it could indicate a cardiac contusion or other more serious internal injuries. Increased tenderness over the sternum and development of a bruise are expected symptoms following trauma to the chest, while a new complaint of leg pain may not be directly related to the initial injury.

Question 9

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?

Accepted Answer

The mechanism of hitting the steering wheel with her chest and presenting with a moderate strength and irregular pulse, along with chest bruising and instability to the sternum, are indicative of a cardiac contusion. This is a potentially life-threatening condition that requires immediate medical attention. Pneumothorax and tension pneumothorax may present with similar symptoms but are less likely given the assessment findings. Traumatic asphyxia is characterized by a distinct pattern of injuries to the head, neck, and upper chest, which are not mentioned in this scenario.

Question 10

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:

Accepted Answer

The patient's presentation is consistent with the clinical findings of pericardial tamponade, which occurs when blood accumulates in the pericardial sac, compressing the heart and limiting its ability to fill and pump. The patient's weak and rapid pulse, tachypneic respirations, low blood pressure, and cool, diaphoretic skin are all signs of circulatory compromise, which are often observed in tamponade. While other conditions such as pneumothorax, hemothorax, and flail segment may cause respiratory distress, they are not likely to cause the same degree of hemodynamic instability seen in tamponade.

Question 11

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

Accepted Answer

Lifting one side of the occlusive dressing during expiration allows for release of trapped air and prevents the development of a tension pneumothorax. It is important to not completely remove the dressing as this may exacerbate the situation. Gentle pressure to the chest during inspiration may also be helpful, but the priority action is to release the trapped air. Ensuring that all four sides of the dressing are taped is important for maintaining a seal, but does not address the potential development of a tension pneumothorax.

Question 12

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?

Accepted Answer

Bluish discoloration to the neck and face is a classic sign of traumatic asphyxia, which occurs when a mechanical force, such as a compression, impacts the chest and impedes venous blood flow back to the heart, leading to a back-up of blood into the neck, head, and face. Choices A, B, and D are not indicative of traumatic asphyxia. A sucking chest wound may indicate a tension pneumothorax, abdominal bruising and distention may indicate internal bleeding or organ damage, and bilateral femur deformity may indicate fractures.

Question 13

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?

Accepted Answer

Monitoring breath sounds is essential in this patient to assess for any indication of a pneumothorax or other injury to the chest or lungs. Aspirin is not typically given for pain in this scenario, and ice or a bulky dressing would not be appropriate interventions.

Question 14

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?

Accepted Answer

Decreased breath sounds to the left lung could indicate a collapsed lung, which is a potentially life-threatening condition that requires immediate attention. The other options, while concerning, are not as immediately critical.

Question 15

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

Accepted Answer

Respiratory distress and the signs and symptoms of shock would be the most significant finding to reinforce the suspicion of a hemothorax. A hemothorax is the accumulation of blood in the pleural space, which can lead to compression of the lung and impaired oxygenation, resulting in respiratory distress. Additionally, the loss of blood can lead to signs and symptoms of shock, such as tachycardia, hypotension, and increased respiratory rate. Neck vein distention and absent breath sounds to the right lung (A) would suggest a tension pneumothorax. Cyanosis and a blood pressure of 210/100 mmHg (B) would suggest severe hypoxia and hypertension, potentially due to pulmonary embolism. Bradycardia and hypertension (C) would be an unlikely finding in a patient with a hemothorax.

Question 16

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:

Accepted Answer

In this scenario, maintaining oxygenation is the primary focus as an open chest wound could lead to a tension pneumothorax or hemothorax, which can obstruct adequate oxygen flow and cause respiratory distress. Pain management and preventing wound infection are important secondary concerns, while providing emotional support to the patient and family is not the primary focus at the moment.

Question 17

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

Accepted Answer

Damage to the pleural membranes can cause a pneumothorax, which is the accumulation of air in the pleural space between the lung and the chest wall. This can compress the lung and impair ventilation. Damage to the other structures listed (mediastinum, trachea, pulmonary arteries) may also impact ventilation, but they are not specifically associated with pneumothorax.

Question 18

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

Accepted Answer

Occlusive dressings are placed over both types of wounds to prevent air from entering and to reduce the risk of infection.

Question 19

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:

Accepted Answer

Lifting the dressing from the wound for several seconds can help relieve a potential tension pneumothorax, which is likely given the patient's symptoms of difficulty breathing and diminished breath sounds on the side of the injury. This action allows trapped air to escape, potentially stabilizing the patient's condition temporarily until definitive care can be provided.

Question 20

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?

Accepted Answer

Reassessing for paradoxical motion of the chest wall is essential during transport as it may develop later and can indicate a tension pneumothorax, which requires immediate treatment.

Quiz 34: Chest Trauma