CH 31 Chest and Abdominal Trauma Flashcards
H-1) An open abdominal wound with protruding organs is called: A. an evisceration. B. a puncture wound. C. an unstable abdomen. D. a flail abdomen.
A. an evisceration.
An evisceration is an intestine or other internal organ protruding through a wound in the abdomen.
H-2) When a patient who has a flail segment exhales, the segment of the ribs will push outward while the rest of the chest cavity pulls inward. This is referred to as: A. subcutaneous emphysema. B. paradoxical motion. C. unequal respiration. D. fractional expansion.
B. paradoxical motion.
The movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity is called paradoxical motion.
H-3) A pneumothorax may occur when:
A. a fractured rib breaks through the skin of the outer chest and keeps the wound sealed with the bone end.
B. a hemothorax caused by a penetrating wound to the chest is left untreated for an extended period.
C. a sucking chest wound is sealed with an occlusive dressing that is taped on only three sides.
D. air leaks into the chest cavity from a damaged lung with no opening through the outer chest.
D. air leaks into the chest cavity from a damaged lung with no opening through the outer chest.
Pneumothorax occurs when air accumulates in the potential space in the area where the lung tissue adheres to the chest wall. When air accumulates in this space, it pushes lung tissue away from the chest wall, causing collapse of the lung. Air can enter this space through an external wound or through escape from a punctured lung. Occasionally both events may occur.
H-4) Which of the following best describes an open chest wall injury?
A. A patient with pericardial tamponade following a blow to the chest from a baseball bat
B. Blunt trauma to the sternum during a sporting event
C. A patient trapped under a car
D. Knife wound to the left anterior chest
D. Knife wound to the left anterior chest
A knife wound is a type of mechanism that can cause an open chest wall injury. The other options are more likely to cause a closed chest injury.
H-5) A 34-year-old female patient received a small-caliber gunshot wound to the right anterior chest. She is complaining of dyspnea. Her respirations are 22 and shallow. This patient is presenting with: A. a cardiac tamponade. B. a flail chest. C. an open pneumothorax. D. a pulmonary embolism.
C. an open pneumothorax.
The location and type of trauma and the reduced breath sounds indicate an open pneumothorax, and the lack of hyperresonance does not exclude pneumothorax.
H-6) Your patient has received a blunt trauma injury to the chest from being hit with a baseball bat. You notice a flail segment, lung sounds are diminished, and the patient is having difficulty breathing. You note that the patient's trachea is deviating toward the uninjured side. You suspect: A. a pneumothorax. B. a hemothorax. C. an open wound that you cannot see. D. a tension pneumothorax.
D. a tension pneumothorax.
A tension pneumothorax occurs when air accumulates in the pleural cavity until the lung collapses, and the pressure buildup will eventually start to shift the intrathoracic contents toward the contralateral side of the injury. This injury can happen with either blunt or penetrating trauma.
H-7) Paradoxical motion is caused by:
A. increased use of the diaphragm to breathe because of injury to the chest.
B. a flail segment moving in the direction opposite to the movement of the uninjured side of the rib cage.
C. a tension pneumothorax limiting the expansion of the injured side of the chest.
D. a damaged lung’s not inflating as much as the undamaged lung.
B. a flail segment moving in the direction opposite to the movement of the uninjured side of the rib cage.
During inhalation and exhalation, the flail segment displays paradoxical motion; that is, the flail segment moves in a direction opposite to the movement of the rest of the chest wall.
H-8) You are treating a patient who was diagnosed with multiple rib fractures following a motor vehicle collision. You note equal chest rise and fall. He appears short of breath as well as pale, cool, and diaphoretic. Given the patient's presentation as well as his acute medical history, what condition is he most likely to suffer? A. Flail chest B. Hemothorax C. Tension pneumothorax D. Pneumothorax
B. Hemothorax
Hemothorax can be caused when lacerations within the chest cavity are produced by penetrating objects or fractured ribs. Blood will flow into the space around the lung, the lung may collapse, and the patient will experience a loss of blood, leading to shock.
H-9) Emergency care of a patient with an open chest wound should include:
A. applying an occlusive dressing taped on three sides to any open chest wound.
B. removing the occlusive dressing if the patient’s breathing status deteriorates.
C. immediate removal of any impaled object from the chest wound.
D. positioning the patient on the uninjured side, so that the lung can inflate more fully.
A. applying an occlusive dressing taped on three sides to any open chest wound.
Apply an occlusive dressing to seal the wound (not a regular porous dressing, which would allow air to enter easily). The occlusive dressing should be a few inches wider than the wound. Place it over the entire wound, and tape it on three sides.
H-10) Which of the following signs and symptoms would lead you to believe that your patient had a tension pneumothorax?
A. Decreased blood pressure
B. Severely decreased or absent breath sounds on the injured side
C. Paradoxical motion
D. Tachycardia
B. Severely decreased or absent breath sounds on the injured side
Severely decreased or absent breath sounds on the injured side are the most serious of the signs and symptoms listed that would indicate development of a tension pneumothorax
H-11) A tension pneumothorax differs from a simple pneumothorax in that:
A. a tension pneumothorax seals off any wounds as a result of the increased pressure.
B. a tension pneumothorax puts pressure on the heart, the great vessels, and the unaffected lung.
C. a simple pneumothorax is not a serious emergency.
D. a simple pneumothorax is not caused by an external open wound.
B. a tension pneumothorax puts pressure on the heart, the great vessels, and the unaffected lung.
If there is no opening to the outside chest, air that leaks from the lung has no avenue of escape. Pressure builds up in the chest cavity, compressing the heart, the great vessels, and the unaffected lung.
H-12) Blunt abdominal trauma that causes the perforation of a vascular structure in the abdomen may cause:
A. spinal cord damage to motor nerve roots.
B. loss of function to the lower extremities.
C. significant blood loss.
D. rupture of the urinary bladder, with resultant chemical inflammation
C. significant blood loss.
An injury to a vascular structure such as the liver or spleen typically involves a serious and often life-threatening hemorrhage. There is often heavy blood loss into the abdominal compartment that may go unrecognized for a period of time.
H-13) Why should the EMT complete a full assessment on a patient with a bullet wound to the abdomen?
A. To determine whether transport is necessary
B. To determine how straight the bullet’s trajectory was
C. To definitively identify all injured organs
D. To determine the probable extent of injuries
D. To determine the probable extent of injuries
Penetrating abdominal wounds can be associated with wounds in adjacent areas of the body. For example, a bullet can enter the chest cavity, pierce the diaphragm, and cause widespread damage in the abdomen. A complete patient assessment is essential in determining the probable extent of injuries. Always assess for an exit wound. Bullet trajectories are rarely straight, and internal damage cannot be easily assessed, so determining the straightness of the bullet’s trajectory and definitively identifying all injured organs is likely impossible in a prehospital setting. Transport is mandatory.
H-14) An object that is impaled in the abdomen should be: A. stabilized in place. B. twisted while being pulled out. C. immediately removed. D. slowly removed.
A. stabilized in place.
Like any impaled object in the trunk of the body, the item should be stabilized in place and not removed by the EMT. The amount of damage that could be caused by pulling it out is unknown, and may be fatal.
H-15) You arrive on scene to an alert 27-year-old male patient with an obvious abdominal evisceration. He is restless, pale, cool, and diaphoretic. After administering high-concentration oxygen, you should immediately:
A. cover the wound with a dressing moistened with saline.
B. use a dry dressing on the wound, covered by aluminum foil.
C. have the patient lie flat.
D. transport.
A. cover the wound with a dressing moistened with saline.
Do not touch or try to replace any eviscerated, or exposed, organs. Apply a sterile dressing moistened with sterile saline over the wound site. Some EMS systems may recommend that you apply an occlusive dressing as well. It may be necessary to remoisten the dressings with additional saline to ensure that the eviscerated organ or organs do not dry out. In cases of large eviscerations, maintain warmth by placing layers of bulky dressing over the moistened dressing.
PT-1) You are treating a 42-year-old male assault victim who presents with nausea, vomiting, and sharp abdominal pain. While inspecting his abdomen, you note redness to his right upper quadrant. Based on your assessment findings, the patient is most likely suffering from which of the following? A. Traumatic hemorrhage of the liver B. Acute appendicitis C. Trauma to the abdominal aorta D. Traumatic hemorrhage of the spleen
A. Traumatic hemorrhage of the liver
PT-2) What is the purpose of a flutter-valve occlusive dressing?
A. To allow air to escape but not enter
B. To allow air to enter but not escape
C. To allow free movement of air without risk of infection
D. To prevent all movement of air
A. To allow air to escape but not enter
PT-3) Which of the following is most clearly an example of an open chest injury? A. Commotio cordis B. Sucking chest wound C. Hemothorax D. Pneumothorax
B. Sucking chest wound
PT-4) Which patient most likely has an abdominal injury?
A. Patient complains of hypoglycemia.
B. Patient complains of hunger.
C. Patient tries to lie still with legs drawn up.
D. Patient speaks loudly and rapidly.
C. Patient tries to lie still with legs drawn up.
PT-5) An open wound to the chest, if an occlusive dressing is not available, should be sealed:
A. immediately with a gloved hand.
B. upon completion of the history and physical examination.
C. only if bubbles are seen in the blood coming from the wound.
D. immediately with a bulky trauma dressing.
A. immediately with a gloved hand.
PT-6) Injury to which of the following organs would be most likely to cause peritonitis? A. Ovary B. Lung C. Small intestine D. Spleen
C. Small intestine
PT-7) What type of injury is likely to produce a flail segment? A. Blunt trauma B. Pneumothorax C. Penetrating trauma D. Open chest wound
A. Blunt trauma
PT-9) You respond to the scene of a 24-year-old gunshot victim and find your patient to have a decreased mental status as well as hypotension. You note absent breath sounds on the left side of his chest, where you notice a puncture wound. From what is this patient most likely suffering? A. Pericardial tamponade B. Commotio cordis C. Flail chest D. Tension pneumothorax
D. Tension pneumothorax
PT-9) You respond to the scene of a 24-year-old gunshot victim and find your patient to have a decreased mental status as well as hypotension. You note absent breath sounds on the left side of his chest, where you notice a puncture wound. From what is this patient most likely suffering? A. Pericardial tamponade B. Commotio cordis C. Flail chest D. Tension pneumothorax
D. Tension pneumothorax
PT-10) When air is present in the chest cavity, the injury is called a: A. tension pneumothorax. B. pneumothorax. C. sucking chest wound. D. hemothorax.
B. pneumothorax.
