Ch. 38

Question 1

A flail segment occurs when:

A) the mechanism of injury involves penetrating trauma.
B) a tension pneumothorax has occurred.
C) at least two ribs are broken during a blunt trauma incident.
D) two or more ribs are broken in two or more places.

Answer 1

D) two or more ribs are broken in two or more places.

Page Ref: 868
Objective: 38.1 Define key terms introduced in this chapter; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 2

Which of the following statements about flail segments is FALSE?

A) Ventilation is sufficient if only two ribs are involved in the flail segment.
B) The chest wall will have paradoxical movement.
C) The patient will have impaired ventilation as a result of instability to chest wall.
D) The flail segment is unable to float freely during respiration.

Answer 2

A) Ventilation is sufficient if only two ribs are involved in the flail segment.

Page Ref: 868
Objective: 38.1 Define key terms introduced in this chapter; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 3

A patient with a history of COPD experiences a sudden onset of sharp chest pain. Your exam reveals an anxious patient who is breathing rapidly and has diminished breath sounds to the left lower lobe of the lung and midline trachea. The patient has MOST likely experienced a:

A) sucking chest wound.
B) flail segment.
C) tension pneumothorax.
D) simple pneumothorax.

Answer 3

D) simple pneumothorax.

Page Ref: 869
Objective: 38.1 Define key terms introduced in this chapter; 38.4 Relate assessment findings to suspicion for specific types of chest injuries; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 4

Air accumulation in the thorax that causes displacement of the mediastinum will result in a condition known as:

A) flail segment.
B) tension pneumothorax.
C) sucking chest wound.
D) simple pneumothorax.

Answer 4

B) tension pneumothorax.

Page Ref: 869
Objective: 38.1 Define key terms introduced in this chapter; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 5

As you are treating a patient with blunt trauma to the chest, oxygen saturation begins falling and the patient experiences hemoptysis. Lung sounds are clear and equal bilaterally but diminished due to painful breathing. You suspect:

A) simple pneumothorax.
B) cardiac tamponade.
C) tension pneumothorax.
D) pulmonary contusion.

Answer 5

D) pulmonary contusion.

Page Ref: 868-869
Objective: 38.1 Define key terms introduced in this chapter; 38.4 Relate assessment findings to suspicion for specific types of chest injuries; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 6

A condition in which blood accumulates in the sac surrounding the heart is called:

A) traumatic asphyxia.
B) pulsus paradoxus.
C) pericardial tamponade.
D) jugular venous distention.

Answer 6

C) pericardial tamponade.

Page Ref: 872-873
Objective: 38.1 Define key terms introduced in this chapter; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 7

Which of the following BEST describes a flail chest?

A) Four or more adjacent ribs, fractured in three or more places
B) Two or more adjacent ribs, fractured in two or more places
C) Three or more adjacent ribs, fractured in four or more places
D) Three or more adjacent ribs, fractured in two or more places

Answer 7

B) Two or more adjacent ribs, fractured in two or more places

Page Ref: 868
Objective: 38.1 Define key terms introduced in this chapter; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 8

When auscultating the lungs of a trauma victim, you are listening for:

A) crackling and popping.
B) equal, bilateral breath sounds.
C) hemoptysis.
D) paradoxical motion.

Answer 8

B) equal, bilateral breath sounds.

Page Ref: 865-866
Objective: 38.2 Explain the relationship between an intact thoracic cavity and lungs, and ventilation, oxygenation, and respiration.

Question 9

________ is a major cause of death in traumatic injuries.

A) Head injury
B) Internal abdominal bleeding
C) Hypovolemic shock
D) Blunt thoracic trauma

Answer 9

D) Blunt thoracic trauma

Page Ref: 862
Objective: 38.2 Explain the relationship between an intact thoracic cavity and lungs, and ventilation, oxygenation, and respiration.

Question 10

The MOST important aspect of care when treating a suspected thoracic injury is:

A) chest decompression.
B) pain medications.
C) ventilation and oxygenation.
D) intravenous therapy.

Answer 10

C) ventilation and oxygenation.

Page Ref: 862
Objective: 38.2 Explain the relationship between an intact thoracic cavity and lungs, and ventilation, oxygenation, and respiration.

Question 11

You are treating the victim of a shooting who has an open chest wound that has been covered by an occlusive dressing. You notice the patient is now anxious, short of breath, and tachycardic. Your next action should be to:

A) insert a supraglottic airway rapidly.
B) defibrillate at 200J if heart rate exceeds 200 bpm.
C) establish large-bore IVs and administer fluid.
D) lift one side of the occlusive dressing.

Answer 11

D) lift one side of the occlusive dressing.

Page Ref: 871
Objective: 38.2 Explain the relationship between an intact thoracic cavity and lungs, and ventilation, oxygenation, and respiration; 38.4 Relate assessment findings to suspicion for specific types of chest injuries; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 12

Why is an occlusive dressing, taped on three sides, used in a patient with an open pneumothorax?

A) It converts an open pneumothorax into a spontaneous pneumothorax, limiting the aspiration of air and enhancing pressure build-up.
B) It converts an open pneumothorax into a tension pneumothorax, limiting the aspiration of air and relieving pressure build-up.
C) It converts an open pneumothorax into a simple pneumothorax, reducing the aspiration of air and relieving pressure build-up.
D) It converts an open pneumothorax into a hemopneumothorax, limiting the aspiration of blood and relieving pressure build-up.

Answer 12

C) It converts an open pneumothorax into a simple pneumothorax, reducing the aspiration of air and relieving pressure build-up.

Page Ref: 871
Objective: 38.2 Explain the relationship between an intact thoracic cavity and lungs, and ventilation, oxygenation, and respiration; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 13

Which of the following MOST accurately depicts the chest wall movement in a patient with flail segment?

A) Inward with both inspiration and expiration
B) Inward with expiration and outward with inspiration
C) Outward with both inspiration and expiration
D) Inward with inspiration and outward with expiration

Answer 13

D) Inward with inspiration and outward with expiration

Page Ref: 868
Objective: 38.4 Relate assessment findings to suspicion for specific types of chest injuries.

Question 14

Which of the following BEST describes the effects of a pericardial tamponade on cardiac output and venous pressure?

A) Cardiac output is low, and central venous pressure rises.
B) Cardiac output rises, and venous pressure is not affected.
C) Cardiac output is not affected, and central venous pressure rises.
D) Cardiac output is high, and central venous pressure falls.

Answer 14

A) Cardiac output is low, and central venous pressure rises.

Page Ref: 872
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 15

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

Answer 15

C) hypoxia.

Page Ref: 868-869
Objective: 38.2 Explain the relationship between an intact thoracic cavity and lungs, and ventilation, oxygenation, and respiration.

Question 16

The AEMT showed that he understands the difference between a simple pneumothorax and a tension pneumothorax when he made which one of the following statements?

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

Answer 16

B) “A tension pneumothorax reduces blood return to the heart; a simple pneumothorax does not affect blood return.”

Page Ref: 869-870
Objective: 38.4 Relate assessment findings to suspicion for specific types of chest injuries; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 17

As you are performing a rapid trauma exam of the chest, you note the presence of a crackling, rice-crispy-like sensation beneath the skin under the clavicles. This is MOST likely:

A) crepitus.
B) subcutaneous emphysema.
C) flail chest.
D) cyanosis.

Answer 17

B) subcutaneous emphysema.

Page Ref: 870
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 18

When a patient suffers penetrating trauma to the chest wall causing a wound that is two-thirds the diameter of the trachea, as the diaphragm moves downward, air will:

A) enter the pleural cavity from outside.
B) not move into the chest cavity.
C) be forced from the chest cavity.
D) accumulate in the lungs.

Answer 18

A) enter the pleural cavity from outside.

Page Ref: 869-871
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma.

Question 19

What injury occurs when there is compression of the chest with forced retrograde blood flow and engorgement of the blood vessels in the upper chest, neck. and head?

A) Myocardial contusion
B) Traumatic asphyxia
C) Hemothorax
D) Commotio cordis

Answer 19

B) Traumatic asphyxia

Page Ref: 871-872
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 20

Which of the following mechanisms of injury would MOST likely cause a deceleration injury resulting in a pulmonary contusion?

A) A patient receives a bullet wound from a .22 gauge shotgun.
B) A patient is struck with a baseball bat.
C) A patient receives a knife wound to the thorax.
D) A patient’s thorax strikes a steering wheel.

Answer 20

D) A patient’s thorax strikes a steering wheel.

Page Ref: 867
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma.

Question 21

Which one of the following statements made by an AEMT shows an understanding of chest trauma?

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

Answer 21

A) “Closed chest injuries are caused by blunt trauma and can be just as serious as open chest injuries.”

Page Ref: 866-867
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma.

Question 22

You are on the scene of a shooting. Your assessment reveals a 23-year-old man 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 makes a sucking sound every time the patient takes a breath. The initial action of the AEMT should be which one of the following?

A) Place direct pressure over the abdominal gunshot wound.
B) Place the patient on high-flow oxygen with a nonrebreather fire mask.
C) Obtain a sterile dressing and cover the chest wound.
D) Cover the chest wound with a gloved hand.

Answer 22

D) Cover the chest wound with a gloved hand.

Page Ref: 871
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 23

Your patient was involved in a serious motor-vehicle collision. Which one of the following assessment findings BEST helps to determine that the patient has a flail segment?

A) Paradoxical chest wall movement
B) Pain with inspiration
C) SpO2 reading lower than 90 percent
D) Shortness of breath

Answer 23

A) Paradoxical chest wall movement

Page Ref: 868
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma; 38.4 Relate assessment findings to suspicion for specific types of chest injuries.

Question 24

A patient has been shot in the chest with a rifle. Your assessment reveals a decreasing level of consciousness and inadequate breathing. Positive pressure ventilation is being administered, and you have covered the entrance wound located midclavicular at the second intercostal space on the left side of the chest. Which one of the following should you do next?

A) Get a full set of vital signs.
B) Place a cervical collar.
C) Look for an exit wound.
D) Obtain a blood pressure.

Answer 24

C) Look for an exit wound.

Page Ref: 864, -867
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma; 38.4 Relate assessment findings to suspicion for specific types of chest injuries.

Question 25

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, which finding should the AEMT consider MOST serious and warrant immediate attention?

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

Answer 25

A) Decreased breath sounds to the left lung

Page Ref: 869-871
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma; 38.4 Relate assessment findings to suspicion for specific types of chest injuries.

Question 26

Which of the following statements about tension pneumothorax is FALSE?

A) Lung collapse will occur on the side of the injury.
B) Hypotension will occur when venous return is impaired.
C) JVD occurs when the vena cava becomes crimped.
D) Tracheal deviation is the most prevalent and common early sign of tension pneumothorax.

Answer 26

D) Tracheal deviation is the most prevalent and common early sign of tension pneumothorax.

Page Ref: 871
Objective: 38.4 Relate assessment findings to suspicion for specific types of chest injuries; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 27

The presence of a potential myocardial contusion should be based on:

A) an open chest wound.
B) penetrating chest trauma.
C) significant blunt chest trauma.
D) a history of COPD.

Answer 27

C) significant blunt chest trauma.

Page Ref: 872
Objective: 38.3 Relate mechanism of injury to the potential for specific types of chest trauma.

Question 28

Which of the following is the MOST appropriate prehospital management for a patient with a flail segment?

A) Placing IV fluid bags on the chest
B) Placing a sandbag that weights 15 pounds on the injured side
C) Needle decompression
D) Positive pressure ventilation

Answer 28

D) Positive pressure ventilation

Page Ref: 869
Objective: 38.4 Relate assessment findings to suspicion for specific types of chest injuries; 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 29

When assessing a patient who sustained blunt trauma to the chest, which one of the following assessment findings is MOST indicative of an injury to the lung?

A) Elevated heart rate and blood pressure
B) Respiratory rate of 20 breaths per minute
C) Inability to speak more than a few words without gasping
D) Ecchymotic area to the anterior chest

Answer 29

C) Inability to speak more than a few words without gasping

Page Ref: 868-869
Objective: 38.4 Relate assessment findings to suspicion for specific types of chest injuries.

Question 30

An adult female is found unresponsive after being shot in the chest. Which one of the following AEMT statements about this patient is of MOST concern?

A) “She does not have any jugular venous distention.”
B) “I see an entry wound but no exit wound anywhere.”
C) “She is getting more difficult to ventilate.”
D) “Her SpO2 has gone from 90 percent to 93 percent.”

Answer 30

C) “She is getting more difficult to ventilate.”

Page Ref: 871
Objective: 38.4 Relate assessment findings to suspicion for specific types of chest injuries.

Question 31

A 42-year-old man was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled in the man’s chest, 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) Remove the knife and seal the injury with a dressing.
C) Stabilize the knife with bulky dressings.
D) Provide positive pressure ventilation.

Answer 31

A) Suction the blood from the airway.

Page Ref: 865
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 32

A construction foreman has been stabbed in the right anterior chest with a screwdriver by an angry worker. He is conscious and oriented and complaining of pain to the injury site. Prior to your arrival, he removed the screwdriver. Your primary assessment reveals a patent airway, adequate breathing, and strong radial pulse. Based on these findings, you should:

A) administer oxygen through a nonrebreather mask.
B) take manual inline spinal stabilization.
C) insert a nasopharyngeal airway.
D) open the airway using the jaw-thrust maneuver.

Answer 32

A) administer oxygen through a nonrebreather mask.

Page Ref: 865
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 33

A paramedic has asked that you apply a dressing over a sucking chest wound to the left anterior chest. Which one of the following should you use to cover the injury?

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

Answer 33

A) An airtight dressing such as Vaseline gauze

Page Ref: 871
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 34

Which of the following BEST explains why positive pressure ventilation is the correct management step for a patient with flail segment?

A) The positive pressure limits any movement of the thorax, thus allowing only the unaffected side to be ventilated.
B) The positive pressure accentuates movement of the thorax inward, reducing the movement of the fracture site and moving the flail segment with the chest.
C) The positive pressure permanently inflates the flail segment in order to maximize oxygenation.
D) The positive pressure displaces the thorax outward, reducing the movement of the fracture site and moving the flail segment with the chest.

Answer 34

D) The positive pressure displaces the thorax outward, reducing the movement of the fracture site and moving the flail segment with the chest.

Page Ref: 868-869
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 35

Beck’s triad is often found in a pericardial tamponade. Which three of the following findings does it include?
1. JVD
2. Hypotension
3. Wheezing
4. Muffled heart sounds
5. Stridor

A) 1, 3, 4
B) 2, 3, 5
C) 1, 2, 4
D) 3, 4, 5

Answer 35

C) 1, 2, 4

Page Ref: 873
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.

Question 36

A blow to the chest resulting in sudden cardiac arrest is referred to as:

A) commotio cordis.
B) traumatic asphyxia.
C) myocardial stunning.
D) pericardial tamponade.

Answer 36

A) commotio cordis.

Page Ref: 872
Objective: 38.5 Explain the pathophysiology and management of the following types of chest injuries: blunt cardiac injury, commotio cordis, flail chest, hemothorax, myocardial contusion, open pneumothorax, penetrating cardiac injury, pericardial tamponade, pulmonary contusion, rib fractures, simple pneumothorax, tension pneumothorax, and traumatic asphyxia.