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Paramedic Care Volume 5 - Trauma > Chapter 8 - Thoracic Trauma > Flashcards

Chapter 8 - Thoracic Trauma Flashcards

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1
Q

About what percentage of vehicle deaths are attributable to thoracic injuries?

A

pg 189

25%

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2
Q

Which of the following is located within the thorax?

The heart

The trachea

Both lungs

The esophagus

All of the above

A

pg 189

All of the above

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3
Q

How many floating rib pairs are there?

A

pg 190

Two

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4
Q

List the lines is used to describe position on the chest wall?

A

pg 190

Posterior axillary line

Midclavicular line

Anterior axillary line

Medial axillary line

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5
Q

How high does the diaphragm rise in the chest during a maximum expiration?

A

pg 190

To the 6th intercostal space posteriorly

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6
Q 
The muscle(s) of respiration responsible for reducing the distance between ribs and helping lift
 the thorax is (are) the
A

pg 190

intercostal muscles.

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7
Q

The structure that separates the chest cavity from the abdominal cavity is the

A

pg 190

diaphragm.

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8
Q

At the beginning of and during most of expiration, the pressure within the thorax is

A

pg 190

more than the atmospheric pressure.

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9
Q

Which structure(s) enter(s) or exit(s) the lungs at the pulmonary hilum?

A

pg 190

Right mainstem bronchus

Pulmonary artery

Pulmonary veins

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10
Q

T/F - The right lung has only two lobes because the heart’s greatest mass is on the right.

A

pg 190

False

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11
Q

The serous structure that ensures the lungs expand with the thoracic cage wall and diaphragm is the

A

pg 190

pleura.

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12
Q

Which of the following act(s) as a shut-off switch for respiration?

A

pg 191

The apneustic center

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13
Q

Which of the following structures is NOT located within the mediastinum?

Thoracic duct

Vagus nerve

Phrenic nerve

Esophagus

Pulmonary hilum

A

pg 191

Pulmonary hilum

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14
Q

Which of the following statements is NOT true regarding the pericardium?

A. The pericardial fluid is straw colored.
B. The pericardial fluid acts as a lubricant.
C. The pericardium normally contains no more than 5 mL of fluid.
D. The epicardium and visceral pericardium are one and the same.
E. The fibrous pericardium is not the parietal pericardium.

A

pg 191

The pericardium normally contains no more than 5 mL of fluid.

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15
Q

The outer layer of the heart is the

A

pg 191

epicardium.

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16
Q

The intercostal arteries and nerves run

A

pg 191

below the ribs.

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17
Q

Which of the following is NOT likely to be associated with blunt trauma?

A

pg 192

Pericardial tamponade

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18
Q

Which of the following is NOT likely to be associated with penetrating trauma?

A

pg 192

Traumatic asphyxia.

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19
Q

Rib fracture is found in about what percent of significant chest trauma?

A

pg 194

50 percent

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20
Q

Which ribs are fractured the most frequently

A

pg 194

4 through 8

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21
Q

Which rib group, when fractured, is most frequently associated with aortic rupture?

A

pg 194

Ribs 1 and 3

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22
Q

Which of the following groups is more likely to experience internal injury without rib fracture?

A

pg 195

Pediatric patients

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23
Q

Which of the following are associated with a rib fracture?

Local pain

Hemothorax

Crepitus

Limited chest excursion

All of the above

A

pg 195

All of the above

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24
Q

Which of the following is most frequently associated with sternal fracture?

Hemothorax

Simple pneumothorax

Blunt cardiac injury

Open pneumothorax

Esophageal injury

A

195

Blunt cardiac injury

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25
Q

Air from under the flail segment in flail chest does which of the following?

Moves out from under the segment during expiration

Moves toward the mediastinum during expiration

Does not move with the segment

Moves out from under the segment during inspiration

None of the above

A

pg 196

Moves out from under the segment during inspiration

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26
Q

As the pain of the flail chest increases with time, the amount of paradoxical movement will
decrease due to muscular splinting.

A

pg 196

False

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27
Q

Simple pneumothorax is associated with what percent of serious thoracic trauma?

A

pg 197

15 - 50%

28
Q

The condition in which a part of the chest wall moves in opposition to the rest of the chest due
to numerous rib fractures is called

A

pg 195

Flail Chest

29
Q

The chest injury that causes the patient to experience increasing dyspnea because of an open or
closed pneumothorax that has a valve-like function and allows intrathoracic pressure to
increase is referred to as

A

pg 198

tension pneumothorax

30
Q

For a significant amount of air to move through an open wound to create an open
pneumothorax, the wound opening must be

A

pg 197

two-thirds the size of the tracheal opening.

31
Q

What is a very late sign of tension pneumothorax?

A

pg 198

Tracheal deviation away from the injury

32
Q

Each hemithorax can hold up to what volume of blood from a hemothorax?

A

pg 199

3,000 mL

33
Q

Which of the following statements is NOT true regarding hemothorax?

Hemorrhage into the thorax is more severe due to decreased pressure there.

Serious hemothorax may displace an entire lung and has a 75 percent mortality rate.

Hemothorax often occurs with pneumothorax.

Hemothorax rarely occurs with simple rib fractures.

None of the above.

A

pg 199

Hemothorax rarely occurs with simple rib fractures.

34
Q

Distant or absent breath sounds heard during auscultation of the chest and the signs of shock
are suggestive of which pathology?

A

pg 199

Hemothorax

35
Q

Which of the following problems would most likely result in a chest area that is dull to percussion?

A

pg 199

Hemothorax

36
Q

Your patient has received chest trauma yet did not initially present with crackles. However, as
the assessment continues, they are heard in both the lower lung fields. This condition is most
likely a result of which of the following?

A

pg 200

Pulmonary contusion

37
Q

T/F - Extensive pulmonary contusions may account for blood losses up to 1,500 mL.

A

pg 200

True

38
Q

The most common cause of blunt cardiac injury is

A

pg 200

blunt anterior chest trauma.

39
Q

A patient presents with the signs of shock, jugular vein distention, distant heart sounds, and a
narrowing pulse pressure. The lung fields are clear. Which condition is most likely the cause?

A

pg 200

Pericardial tamponade

40
Q

Pericardial tamponade occurs with what frequency in serious chest trauma patients

A

pg 201

Less than 2 percent of the time

41
Q

What are signs of pericardial tamponade?

A

pg 202

Pulsus paradoxus

Hypotension

A narrowing pulse pressure

Distended jugular veins

42
Q

A decrease in jugular vein distention during inspiration is known as

A

pg 202

Kussmaul’s sign.

43
Q

A blood pressure drop of more than 10 mmHg with inspiration is known as

A

pg 202

pulsus paradoxus.

44
Q

T/F - If the chamber of the heart is significantly damaged yet does not rupture immediately, it is
likely to rupture in around two weeks.

A

pg 202

True

45
Q

Your patient was involved in a lateral-impact auto collision. The car is greatly deformed,
though the patient does not have many signs of injury. During your assessment, he complains
of a tearing sensation in his central chest and numbness in his left upper extremity. Your
highest index of suspicion of injury is for

A

pg 203

Aortic dissection

46
Q

What percentage of patients with traumatic aortic dissection will survive the initial impact and
injury?

A

pg 202

As high as 20 percent

47
Q

In a patient with a history of blunt lateral trauma and a suspected traumatic aortic dissection,
which signs or symptoms would you expect to find?

A

pg 203

Severe, tearing chest pain
Pulse deficit between extremities
Reduced pulse strength in the lower extremities
Hypertension

48
Q

A harsh systolic murmur is heard over the central chest. This is suggestive of which pathology?

A

pg 203

Traumatic aortic dissection

49
Q

T/F - The right side is the site of most diaphragmatic ruptures because most assailants are
right-handed.

A

pg 203

False

50
Q

The traumatic diaphragmatic rupture is likely to present like which of the following thoracic injuries?

A

pg 204

Tension pneumothorax

51
Q

The two major problems associated with traumatic asphyxia are restriction of chest excursion and

A

pg 204

restriction of venous return.

52
Q

The classic signs of traumatic asphyxia are?

A

pg 204

Bulging eyes
Conjunctival hemorrhage
Petechiae of the head and neck
Dark red or purple appearance of the head and neck

53
Q

Serious penetrating trauma will likely require what Standard Precaution procedures?

A

pg 205

Gloves

Mask

Face shield

Gown

54
Q

During your assessment of a supine patient with blunt chest trauma, you notice slight jugular
vein distention. With no other signs of injury, this suggests which of the following?

A

pg 206

A normal patient

55
Q

Crackles heard during auscultation of the chest are suggestive of which pathology?

A

pg 206

Pulmonary contusion

56
Q

Hyperresonance heard during percussion of the chest is suggestive of which pathology?

A

pg 207

Tension pneumothorax

&

pneumothorax

57
Q

Which of the following thoracic structures takes the least energy to fracture and often results
as a more common, yet less serious, thoracic injury?

A

pg 207

Ribs 4 through 8

58
Q

A patient who displays subcutaneous emphysema is most likely to have which of the following
conditions?

A

pg 207

Tension pneumothorax

59
Q

T/F - Overdrive ventilation (bag-valve masking) of the patient with flail chest will cause the flail
segment to move with, rather than in opposition to, the chest wall.

A

pg 209

True

60
Q

Which of the following is an indication for the use of IV infusion?

A. Diaphragmatic rupture
B. Penetrating chest injury
C. Chest trauma with a blood pressure below 80
D. Chest trauma with a blood pressure below 50
E. Suspected pericardial tamponade

A

pg 209

C. Chest trauma with a blood pressure below 80

61
Q

T/F - Meperidine, diazepam, or morphine may be given to the minor rib fracture patient to reduce
pain and increase respiratory excursion.

A

pg 209

True

62
Q

The patient who is suspected of a flail chest or other thoracic cage injury, without suspected
spine injury, should be positioned

A

pg 209

on the injured side.

63
Q

The open pneumothorax should be cared for using which of the following techniques?

A. Pack the wound with a sterile dressing.
B. Cover the wound with an occlusive dressing and tape securely.
C. Cover the wound with an occlusive dressing, taped on three sides.
D. Attempt to close the wound with a hemostat and then cover with a sterile dressing.
E. Cover the wound loosely with a sterile dressing.

A

pg 210

C. Cover the wound with an occlusive dressing, taped on three sides.

64
Q

Which location is recommended for prehospital pleural decompression?

A

pg 210

2nd intercostal space, midclavicular line

65
Q

A few minutes after you have inserted a needle and decompressed a tension pneumothorax,
you notice that a patient’s dyspnea is getting worse and breath sounds on the injured side are
becoming diminished. Which action would you take?

A

pg 210

Insert a second needle.

66
Q

A patient is trapped in a wrecked auto for about half an hour and is suspected of having
traumatic asphyxia. Care should include?

A

pg 212

Two large-bore IVs
Normal saline or lactated Ringer’s solution
Fluids run rapidly
Consideration of sodium bicarbonate

Paramedic Care Volume 5 - Trauma (11 decks)

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