CH 31 Flashcards
You are stabilizing a patient who has just been stabbed in the chest to the right of the mediastinum. After placing the patient on supplemental oxygen, his shortness of breath resolves. You also cover the wound with an occlusive dressing. The patient is asymptomatic at the time you’re making the decision to transport. Which of the following best encapsulates the correct strategy for transport?
Transport the patient emergently because of the high index of suspicion for a serious injury.
A 36-year-old male was accidentally shot with a nail gun into the chest. You see the nail, which protrudes about 2 to 3 centimeters from the thorax, when you visualize the injury site. Under which of the following circumstances should you remove the nail from the injury site?
none
Which of the following describes the proper application of an occlusive dressing for an open chest wound?
Apply an occlusive dressing to each penetrating wound.
A patient with jugular vein distention is most likely suffering from which of the following injuries?
Tension pneumothorax
Your patient is a 17-year-old male baseball player found pulseless and apneic after being struck in the chest by a baseball 6 minutes ago. He is surrounded by other players and staff but no one is providing care. You should:
begin chest compressions.
While palpating the radial pulses of a patient who was involved in a motor vehicle crash, you notice a difference in the strength of the pulses bilaterally. This is a finding that you suspect may be associated with:
aortic dissection.
The pathophysiology of ________ is one in which the pericardial sac fills with blood to the point that the chambers of the heart no longer fill adequately, usually secondary to trauma.
cardiac tamponade
What is the underlying cause of bluish or reddish facial discoloration following traumatic asphyxia?
High pressure on the chest leads to blood being forced from the right atrium into the face and neck.
You have covered an open chest wound with your gloved hand, and the patient’s breathing has improved. In order to free your hand to provide further care, you should:
cover the wound with an occlusive dressing.
The mechanism of injury in which a patient’s chest has struck an immovable object, such as a steering wheel, may most accurately be described as a(n):
compression injury.
For which of the following wounds should the EMT apply an absorbent dressing moistened with sterile saline?
Gunshot wound to the abdomen from which a loop of intestine is protruding
You’re an off-duty EMT who encounters a patient sitting behind the wheel of a vehicle that ran off an isolated county road. It appears the patient was not wearing a seat belt and struck the steering wheel with his chest. On assessment, you notice a paradoxical motion to the patient’s chest on inspiration and expiration. When you radio for dispatch of an ambulance, which of the following pieces of information would you be sure to include?
The patient may have a flail chest.
Your patient is a 21-year-old male who has a sucking gunshot wound to the chest. Which of the following is the highest priority in managing this patient?
Placing an occlusive dressing over the wound
Your patient has an open abdominal wound with intestines protruding. You should:
cover the organs with moist sterile dressings.
On assessment of the midsection of a 32-year-old male who was struck by a car, you find an abdominal evisceration with several loops of his large intestine exposed. The abdomen appears to have a clean-cut laceration, and the bleeding is controlled. Which of the following is the best approach toward managing the exposed intestines?
Moisten a sterile dressing with saline solution and cover the abdominal contents.
You are caring for a 27-year-old male who has a puncture wound to the right upper chest. The patient was stabbed with a serrated steak knife by his ex-girlfriend. You have placed an occlusive dressing on the site and begun emergent transport to the closest trauma center. However, while en route the patient begins to complain of increasing shortness of breath. You notice a decrease in ventilatory volume and an increase in thoracic diameter. Which of the following options would be the best step to perform next?
Free a corner or edge of the dressing to release pressure buildup.
You are on an EMS standby for a boxing tournament. During one of the matches, one of the female boxers delivers a forcible uppercut to the chest of her opponent, who falls to the ground. The match is declared over on the basis of a TKO. However, the opponent fails to arise following a 1- to 2-minute interval. EMS is summoned to the ring. You find the patient pulseless and breathing agonal gasps. You suspect which of the following traumatic conditions?
Commotio cordis
Which of the following is a vascular organ in the abdomen that can produce blood loss quickly enough to result in life-threatening hemorrhage following high mechanism of injury blunt trauma?
liver
You are palpating the abdomen of a motor vehicle collision patient when you feel a pulsating mass. You should:
defer further abdominal palpation
Which of the following best describes an evisceration?
Open wound of the abdomen from which organs protrude
Bleeding from open abdominal injuries should initially be controlled with which one of the following techniques?
Applying direct pressure to the wound
Which of the following injuries may produce distended neck veins?
Traumatic asphyxia
B.
Cardiac tamponade
C.
Tension pneumothorax
You find a middle-aged male sitting against a wall in obvious distress. The patient appears to be extremely short of breath and has an open wound to his chest that is making a sucking sound. You should:
place your gloved hand over the wound.
What is the correct terminology for a wound in which a vacuum has been created within the chest, drawing air into the thorax through a penetration of the chest wall with each breath?
Sucking chest wound
Your patient is a 55-year-old male who was found in the parking lot behind a tavern. He states that he was assaulted and robbed by three individuals. He is complaining of being “hit in the face and kicked and punched in his ribs and stomach.” Your examination reveals contusions and swelling around both eyes, bleeding from the nose, a laceration of his upper lip, and multiple contusions of the chest, abdomen, and flanks. Which of the following should cause the greatest concern regarding the prehospital care of this patient?
The potential for serious internal damage
Which of the following is a strategy to maintain adherence of an occlusive dressing to bloody or diaphoretic skin?
Manually maintain pressure.
Which of the following best describes the potential benefit of a three-sided occlusive dressing over a four-sided occlusive dressing for an open chest wound?
It may reduce the chances of developing a tension pneumothorax.
What is a drawback to using sterile aluminum foil as an occlusive dressing?
The foil may lacerate eviscerated organs.
Which of the following is an accurate definition of a flail chest?
Section of the chest wall that is unstable, leading to breathing problems
Common signs and symptoms following an injury to a hollow abdominal organ include:
irritation and peritonitis.
Which of the following is an unreliable sign for determining the presence of a tension pneumothorax?
Trachea that shifts to the side opposite the injury
The chest cavity can hold up to ________ liter(s) of blood in an adult, leading to the possibility of massive internal hemorrhage without any external blood loss.
3
You are treating a patient with paradoxical motion on the left side of the chest. He is breathing is shallow at a rate of 4 breaths per minute. You should:
begin positive pressure ventilation.
Your patient was working on a car when it fell off the jack and trapped him between the tire and ground. His face is very blue and his eyes are bloodshot. Which of the following has the patient most likely suffered?
traumatic asphyxia
You are dispatched to a 42-year-old male who was shot in the abdomen and thrown from a vehicle. The patient is critical and high-category trauma; however, due to the mechanism of injury, it is necessary to backboard the patient prior to transport. What is an important assessment before securing the patient?
Examining the patient for entrance and exit wounds
