Chapter 31 | Chest and Abdominal Trauma

Question 1

List:

mechanisms of chest injuries

3 points

Answer 1

• blunt trauma
• compression
• penetrating objects

Question 2

Fill in the blank:

Blunt trauma to the chest can fracture the [BLANK], [BLANK], and/or [BLANK].

Answer 2

Blunt trauma to the chest can fracture the ribs, sternum, and/or costal (rib) cartilages.

Question 3

Fill in the blank:

Compression chest injuries occur when [BLANK].

(what happens physically)

Answer 3

Compression chest injuries occur when severe blunt trauma causes the chest to rapidly compress.

Question 4

Define:

flail chest

Answer 4

fracture of 2+ consecutive ribs in 2+ places

moves paradoxically to chest

Question 5

Fill in the blank:

[BLANK] occurs when a flail segment moves in the opposite direction of the chest during respiration.

Answer 5

Paradoxical motion occurs when a flail segment moves in the opposite
direction of the chest during respiration

Question 6

Fill in the blank:

Paradoxical motion occurs when a [BLANK] moves in the opposite direction of the chest during respiration.

Answer 6

Paradoxical motion occurs when a flail segment moves in the opposite direction of the chest during respiration

Question 7

Fill in the blank:

Paradoxical motion occurs when a flail segment [BLANK].

(does what?)

Answer 7

Paradoxical motion occurs when a flail segment moves in the opposite direction of the chest during respiration.

Question 8

Describe:

primary treatment for flail chest

Answer 8

use bulky dressing to stabilize flail segment

Question 9

True or false:

When examining an open chest injury, it can be difficult to tell what is injured from entrance wound.

Answer 9

true

Question 10

True or false:

When examining an open chest injury, it should be easy to tell what is injured from entrance wound.

Answer 10

false

it can be difficult to tell solely based on entrance wound

Question 11

Explain:

complications caused by open chest wound that allows air into chest

Answer 11

punctured lung prevents lung from building negative pressure to suck in air

causes lung to collapse

Question 12

Define:

sucking chest wound

Answer 12

direct and penetrating chest wound that punctures lung

leads to pneumothorax if left uncovered

Question 13

Describe:

primary treatment for sucking chest wound

Answer 13

seal wound with occlusive dressing

Question 14

Define:

flutter valve

Answer 14

small hole in occlusive dressing to seal on inhale and let air out on exhale

Question 15

Explain:

difference between pneumothorax, hemothorax, and hemopneumothorax

(physiology)

Answer 15

• pneumothorax: collection of air in pleural space
• hemothorax: collection of blood in pleural space
• hemopneumothorax: collection of air and blood in pleaural space

(pleural space is what surrounds the lungs)

Question 16

Fill in the blank:

Traumatic asphyxia is caused by [BLANK].

Answer 16

Traumatic asphyxia is caused by sudden compression of the chest.

Question 17

Explain:

physiology of traumatic asphyxia

Answer 17

compression of sternum/ribs exerts pressure on heart and lungs

blood is forced out of right atrium into jugular veins (causing ruptured blood vessels and extensive neck/facial bruising)

Question 18

Define:

pericardial tamponade

(aka cardiac tamponade)

Answer 18

fluid accumulation in pericardial sac around heart

leads to decrease in cardiac output (and eventually shock)

Question 19

Define:

pericardium

Answer 19

tough sac around heart that rarely leaks

Question 20

Fill in the blank:

[BLANK] causes increased pressure on heart so chambers cannot fill.

(medical condition)

Answer 20

Pericardial tamponade causes increased pressure on heart so chambers cannot fill causing blood to back up into veins.

Question 21

Fill in the blank:

Pericardial tamponade causes [BLANK] so chambers cannot fill.

Answer 21

Pericardial tamponade causes increased pressure on heart so chambers cannot fill.

Question 22

True or false:

Pericardial tamponade is usually a result of penetrating trauma.

Answer 22

true

Question 23

True or false:

Pericardial tamponade is usually a result of blunt trauma.

Answer 23

false

usually a result of penetrating trauma

Question 24

List:

symptoms of pericardial tamponade

Beck’s triad

Answer 24

• JVD
• muffled heart sounds
• narrowing pulse pressure

Question 25

Define:

Beck’s triad

Answer 25

three medical signs associated with acute pericardial tamponade

(JVD, muffled heart sounds, narrowing pulse pressure)

Question 26

Define:

pulse pressure (PP)

Answer 26

difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP)

Question 27

Fill in the blank:

The [BLANK] is the largest blood vessel in the body.

Answer 27

The aorta is the largest blood vessel in the body.

Question 28

List:

mechanisms of aortic injury

2 points

Answer 28

• penetrating trauma can cause direct trauma
• blunt trauma can sever or tear the aorta

Question 29

List:

signs/symptoms of aortic injury

3 points

Answer 29

• tearing pain
• differences in blood pressure between left and right arms
• signs of shock

Question 30

Define:

commotio cordis

Answer 30

v-fib caused by object hitting chest at very specific time in heartbeat

(usually small things like baseball or hockey puck)

Question 31

Answer:

How common is commotio cordis?

Answer 31

very uncommon

requires strike on chest to meet very specific point in heartbeat cycle

Question 32

True or false:

Internal bleeding can be severe if organs or blood vessels are lacerated or ruptured.

Answer 32

true

Question 33

True or false:

When treating a large evisceration, maintain warmth by placing layers of bulky dressing over occlusive dressing.

Answer 33

true

Question 34

Choose:

Why is it so important to seal holes in the chest from penetrating trauma as early as​ possible?

A. This will keep the blood from leaking out of the wound and into the pleural cavity.

B. The heart cannot fill if there is no air in the chest.

C. The lungs may collapse if air and blood displace lung tissue.

D. A rib may have been​ fractured, which will decrease lung compliance.

Answer 34

C

Question 35

Choose:

A patient with an abdominal injury will likely want to keep the legs in what position to reduce​ pain?

A. Bent

B. Straight

C. Crossed

D. Elevated

Answer 35

A

Question 36

Choose:

You arrive on scene to a​ 34-year-old male gunshot victim lying in his living room​ disoriented, pale,​ cool, and​ diaphoretic, with shallow respirations. You note blood on his shirt at the chest and​ abdomen, and the puncture wound appears to be through the chest.

What is your first priority in treating this​ patient?

A. Administer​ high-flow oxygen via a nonrebreather mask.

B. Locate the gunshot wound on the​ chest, and place your gloved hand over the injury.

C. Use an emergency move to place the patient on the cot and transfer him to the ambulance.

D. Locate the gunshot wound on the​ chest, and retrieve an occlusive dressing from your responder bag.

Answer 36

B

Question 37

Choose:

You are treating a patient who was stabbed in the right side of the anterior chest wall. He has shortness of​ breath, weakness, and rapid breathing. Aside from administering​ oxygen, what is the most appropriate treatment for this​ patient?

A. Apply an occlusive dressing on the chest​ wall, and tape the dressing on three sides.

B. Tape a bulky gauze dressing to the chest.

C. Bind the ribs together with wide tape.

D. Lay the patient in the prone​ position, to minimize chest movement.

Answer 37

A

Question 38

True or false:

A compression injury is when a twisting effect damages the ribs.

Answer 38

false

compression injury is chest collapse by blunt trauma

Question 39

True or false:

Blunt trauma involves various objects penetrating the chest wall.

Answer 39

false

blunt trauma is dull impact against body (not through surface)

Question 40

True or false:

Bullet wounds are a type of penetrating trauma and involve both internal and external injuries.

Answer 40

true

Question 41

True or false:

Any blow to the chest that fractures the ribs and sternum is a compression injury.

Answer 41

false

Question 42

Choose:

When caring for a patient with an impaled object in the​ abdomen, the EMT​ should:

A. remove the object and seal the wound with an occlusive dressing.

B. remove the object if it slips out easily.

C. leave the impaled object in place and stabilize it with bulky dressings.

D. quickly remove the impaled object and apply direct pressure to the wound.

Answer 42

C

Question 43

Fill in the blank:

You [SHOULD/SHOULDN’T] treat an evisceration with a dry, sterile bandage.

Answer 43

You should not treat an evisceration with a dry, sterile bandage.

intestines must stay wet and hydrated

Question 44

Choose:

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.

Answer 44

D

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.

Question 45

Choose:

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.

Answer 45

D

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.

Question 46

Choose:

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

Answer 46

B

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 (causing lung to collapse)

patient will experience a loss of blood (leading to shock)

Question 47

Choose:

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.

Answer 47

A

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 on three sides

Question 48

Choose:

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

Answer 48

B

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

Question 49

Choose:

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.

Answer 49

B

air that leaks from the lung has no avenue of escape if there is no opening to outside chest

pressure builds up in chest cavity (compressing the heart, the great vessels, and unaffected lung)

Question 50

Choose

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

Answer 50

C

the vessels literally hold all the blood… so expect some bleeding

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.

Question 51

Choose:

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.

Answer 51

A

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.

Question 52

Choose:

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

Answer 52

D

air can enter chest cavity from puncture chest wound with nowhere to escape

pressure builds up in chest cavity (compressing the heart, the great vessels, and lung)

pressure increase is what causes hypotension, unilateral absent lung sounds, etc.

Question 53

Choose:

Your patient was just involved in a motor vehicle collision. She is breathing very fast and shallowly. You auscultate her lung sounds and find diminished breath sounds on the right side.

You suspect that the patient is most likely suffering from:

A. hemothorax.

B. hemopneumothorax.

C. simple pneumothorax.

D. tension pneumothorax.

Answer 53

C

Question 54

Choose:

While assessing the abdomen of a 25-year-old female, you note that she has a large piece of glass sticking out of her right upper quadrant.

What should you do?

A. Monitor vitals, and transport right away

B. Stabilize the glass

C. Remove the glass

D. Place the patient in the prone position

Answer 54

B

Question 55

Choose:

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?

A. Reducing the swelling around his eyes by applying a cold pack

B. The possibility of commotio cordis

C. The potential for serious internal damage

D. The presence of any defensive wounds the patient may have sustained

Answer 55

C

Question 56

Fill in the blank:

The chest cavity can hold up to [BLANK] liter(s) of blood in an adult, leading to the possibility of massive internal hemorrhage without any external blood loss.

Answer 56

The chest cavity can hold up to 3 liters of blood in an adult

Question 57

Choose:

What is the underlying cause of bluish or reddish facial discoloration following traumatic asphyxia?

A. The physiological strain of the body results in a flushed appearance and increased risk of a hypertensive event.

B. High pressure on the chest leads to blood being forced from the right atrium into the face and neck.

C. The patient has become hypoxic due to a chest injury, and the finding suggests central cyanosis.

D. The bluish or reddish facial discoloration is not associated with traumatic asphyxia; a pale discoloration is usually present.

Answer 57

B

Question 58

Choose:

Which of the following injuries may produce distended neck veins?

A. Traumatic asphyxia

B. Cardiac tamponade

C. Tension pneumothorax

D. All of the above

Answer 58

D

Question 59

Choose:

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?

A. The patient does not necessarily need transport, so allow him to refuse if he wants.

B. Transport the patient emergently because of the high index of suspicion for a serious injury.

C. Transport the patient non-emergently because​ he’s complaint free.

D. Begin transport non-emergently and upgrade if the​ patient’s condition deteriorates.

Answer 59

B

Question 60

Choose:

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?

A. It may reduce the chances of developing a tension pneumothorax.

B. It prevents the development of a hemothorax by allowing blood to escape.

C. It allows easy access for reexamination of the wound en route to the hospital.

D. It eliminates the need to continue monitoring the patient’s respiratory status.

Answer 60

A

Question 61

Choose:

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:

A. begin positive pressure ventilation.

B. tape the chest to restrict movement.

C. administer 15 lpm oxygen via mask.

D. roll the patient onto his left side.

Answer 61

A

Question 62

Choose:

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?

A. Performing a rapid trauma assessment

B. Placing the patient in the shock position

C. Placing a pressure dressing over the wound to control bleeding

D. Placing an occlusive dressing over the wound

Answer 62

D

Question 63

Choose:

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?

A. Begin providing CPR to the patient.

B. Call dispatch for an ALS intercept en route to the hospital.

C. Begin providing BVM-assisted ventilations to the patient.

D. Free a corner or edge of the dressing to release pressure buildup.

Answer 63

D

Question 64

Choose:

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:

A. aortic dissection.

B. flail chest.

C. commotio cordis.

D. tension pneumothorax.

Answer 64

A

Question 65

Choose:

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?

A. Examining the patient for entrance and exit wounds

B. Searching for presence of diaphoresis, tachycardia, and hypotension

C. Performing a distal neurological assessment

D. Verifying trauma center ER bed availability

Answer 65

A

Question 66

Explain:

difference between open pneumothorax, closed pneumothorax, and tension pneumothorax

Answer 66

• open: puncture between lung and pleural space
• closed: puncture between pleural space and chest
• tension: increase in pressure exerted on lung from pleural space

Question 67

Choose:

You are called to a rodeo where an employee was crushed against a wall by a bull. Airway and circulation are intact, but breathing is punctuated by shortness of breath and pain with inspiration, there are crackles in the lower lung bases bilaterally. The patient is holding his chest and has tenderness to palpation diffusely.

What is the likely injury this patient has sustained?

A. Pulmonary Contusion

B. Pneumothorax

C. Hemothorax

D. Flail chest

Answer 67

A

Pulmonary contusion is most likely due to the history of blunt trauma and presence of chest tenderness and rales (“crackles”) in the lung base. Pneumo- and hemothorax are less likely as they present with decreased lung sounds. Flail chest is usually visible on primary survey. If there is a hemothorax, you should expect a problem with the “C” of ABCs, due to hypovolemia. Here, “circulation” is intact.

Question 68

Choose:

A 32-year-old involved in a car accident is being assessed for internal injury.

Which of the following bruise patterns would raise your suspicion for damage to the diaphragm?

A. A vertical bruise, midline over the sternum

B. An oblique bruise from a clavicle to its contralateral lower abdominal quadrant

C. A peri-umbilical bruise

D. A bruise on either flank above the iliac crest

Answer 68

B

The “seatbelt sign” is an oblique bruise along the thorax and abdomen, with a potential horizontal bruise along the lower quadrants; this should raise your suspicion for diaphragmatic and hepatic injury, the two organs whose injuries are associated with the sign.