Chapter 29

Question 1

chest injuries can involve the …, …, and …

may be the result of blunt trauma, penetrating trauma, or both

Answer 1

heart; lungs; great blood vessels

Question 2

immediately treat injuries that interfere with normal breathing function:
internal bleeding can compress the … and …
air may collect in the chest, preventing …

Answer 2

lungs; heart; lung expansion

Question 3

the chest (thoracic cage) extends from the lower end of the … to the …

Answer 3

neck; diaphragm

Question 4

thoracic skin, muscle, and bones: similarities to other regions
also unique features to allow for … such as …

Answer 4

ventilation; striated muscle

Question 5

the … lies closely along the lowest margin of each rib.
the … covers each lung and the thoracic cavity–> a small amount of pleural fluid between the parietal and visceral pleura allows the lungs to move freely against the … during respiration

Answer 5

neurovascular bundle; pleura; inner chest wall

Question 6

vital organs, such as the heart, are protected by the … –> connected in the back to the …
connected in the front to the …

Answer 6

ribs; vertebrae; sternum

Question 7

the … contains the heart, great vessels, esophagus, and trachea–> a … can develop in this area of the chest
the … is a muscle that separates the thoracic cavity from the abdominal cavity

Answer 7

mediastinum; thoracic aortic dissection; diaphragm

Question 8

the … muscles (between the ribs) contract during inhalation. the … contracts at the same time. they relax during exhalation.
the body should not have to work to breathe when in a resting state

Answer 8

intercostal; diaphragm

Question 9

patients with a spinal injury below … can still breathe from the diaphragm
patients with a spinal injury above … may lose the ability to breathe

Answer 9

C5; C3

Question 10

… (minute volume): amount of air moved through the lungs in 1 minute = … x …
patients with a decreased tidal volume will have an increased … rate

Answer 10

minute ventilation
normal tidal volume x resp rate
resp

Question 11

(chest injuries) closed chest injury:
can cause significant … and …
if the heart is damaged, it may not be able to refill with blood/blood may not be pumped with enough force out of the heart
lung tissue bruising can result in exponential loss of …
… fractures may cause further damage

Answer 11

cardiac; pulmonary contusion; surface area; rib

Question 12

(chest injuries) in an open chest injury, an object penetrates the … itself–> knife, bullet, piece of metal, or broken end of fractured rib
do not attempt to move/remove object

Answer 12

chest wall

Question 13

(chest injuries) blunt trauma to the chest may cause:
…, …, and .. fractures
brusining of the .. and …
damage to the …
vital organs to be torn from their attachment in the chest cavity

Answer 13

rib; sternum; chest wall
lungs; heart
aorta

Question 14

(chest injuries) signs and symptoms: 
pain at the site of injury 
localized pain that is aggravated or increased with ... 
... to the chest wall 
... with palpation of the chest
... injury to the chest
...

Answer 14

breathing
bruising
crepitus
penetrating 
dyspnea

Question 15

(chest injuries) signs and symptoms contd:
….
failure of one or both sides of the chest to expand normally with …
…, … pulse
… blood pressure
…a round the lips/fingernails

Answer 15

hemoptysis; inspiration; rapid, weak; low; cyanosis

Question 16

chest injury patients often have … and .. respirations:
hurts to take a deep breath
patient may not be moving air
auscultate multiple locations to assess for adequate breath sounds

Answer 16

rapid; shallow

Question 17

primary assess–> airway and breathing:
look for e… of the chest wall
check for … motion
apply occlusive dressings to all penetrating injuries
be alert for decreasing ox sat or impending …

Answer 17

equal expansion;
paradoxical
tension pneumothorax

Question 18

for isolated chest injury for secondary assess examine … and … aspects of the chest wall and changes in respirations

Answer 18

anterior; posterior

Question 19

pneumothorax:
commonly called a …
accumulation of … in the pleural space–> blood passing through the collapsed portion of the lung is not …,
you may hear diminished, absent, or abnormal breath sounds

Answer 19

collapsed lung; air; oxygenated

Question 20

(pneumothorax) type of open chest wound:
often called an … or a … wound
rapidly seal the wound with an … dressing
a … valve is a one-way valve
carefully
carefully monitor the patient for tension pneumothorax

Answer 20

open pneumothorax; sucking chest wound; occlusive; flutter

Question 21

Simple pneumothorax
Does not result in major changes in the patient’s cardiac physiology
Commonly due to blunt trauma that results in …
Can often worsen, deteriorate into tension pneumothorax, or develop complications

Answer 21

fractured ribs

Question 22

Tension pneumothorax
Results from ongoing … in the pleural space
Increased pressure in the chest.
Commonly caused by a blunt injury where a fractured rib lacerates a … or …

Answer 22

air accumulation; lung; bronchus

Question 23

hemothorax:
Blood collects in the pleural space from bleeding around the … or from a … or …
Prehospital treatment
EMT cannot control this kind of bleeding.
Provide rapid transport.
The presence of air and blood in the pleural space is a ….

Answer 23

rib cage; lung; great vessel; hemopneumothorax

Question 24

cardiac tamponade:
The protective membrane (pericardium) around the heart fills with …or ….
The heart cannot adequately pump the blood.
Prehospital treatment
Support ….
Provide rapid transport.

Answer 24

blood; fluid; ventilation

Question 25

rib fractures:
common, esp in older people
a fracture of one of the … is a sign of a very substantial MOI
may cause a pneumothorax, hemothorax, or hemopneumothorax
give supp ox

Answer 25

upper four ribs

Question 26

flail chest:
Segment of chest wall becomes …from the rest of the thoracic cage
Detached portion moves … of normal
Prehospital treatment

Answer 26

detached; opposite

Question 27

Pulmonary contusion
Suspect in a patient with a …
Pulmonary alveoli become filled with …, leading to hypoxia
Provide oxygen and positive-pressure ventilation.

Answer 27

flail chest; blood

Question 28

Other fractures
…fractures: Increased index of suspicion for organ injury
… fractures: Possible damage to neurovascular bundle
Suspect …. in medial clavicle fractures.
Be alert to pneumothorax development.

Answer 28

Sternal; Clavicle; supper rib fractures

Question 29

Traumatic asphyxia

Characterized by …, cyanosis in the face and neck, and hemorrhage in the … of the eye

Answer 29

distended neck veins; sclera

Question 30

Traumatic asphyxia (cont’d)
A sudden, severe … of the chest
Suggests an underlying injury to the heart and possibly a …
Provide ventilatory support with oxygen, and monitor vital signs during immediate transport.

Answer 30

compression; pulmonary contusion

Question 31

Blunt myocardial injury
… of the heart muscle
The heart may be unable to maintain adequate blood pressure.
Suspect in all cases of severe … to the chest
Monitor pulse and blood pressure, provide oxygen, and transport immediately.

Answer 31

Bruising; blunt injury

Question 32

Commotio cordis
Injury caused by a … to the chest during a critical portion of the heartbeat
May result in immediate …
Ventricular fibrillation responds positively to defibrillation within the first 2 minutes of the injury.

Answer 32

sudden, direct blow; cardiac arrest

Question 33

Laceration of the great vessels
May result in rapidly fatal ...
Prehospital treatment:
CPR
Ventilatory support and oxygen
Immediate transport
Monitor for shock and changes in vital signs.

Answer 33

hemorrhage