Chapter 7 extended Flashcards
Which of the following is the correct description of a wound that is below the fifth rib, directly
in line with the armpit?
A) Sixth intercostal space, midclavicular
B) Sixth intercostal space, midaxillary line
C) Fifth intercostal space, midclavicular line
D) Fifth intercostal space, midaxillary line
fifth intercostal space, midaxillary line
The morbidity associated with simple pneumothorax is primarily due to which of the following? A) Occlusion of pulmonary circulation B) Increased intrathoracic pressure C) Loss of chest wall integrity D) Ventilation/perfusion mismatc
ventilation perfusion mismatch
On maximal expiration, the diaphragm may be:
A) as high as the fourth intercostal space anteriorly.
B) as high as the second intercostal space anteriorly.
C) as low as the ninth intercostal space anteriorly.
D) as low as the eleventh intercostal space anteriorly.
as high as the fourth intercostal space anteriorly
Which of the following occurs during the onset of inspiration?
A) Intrathoracic pressure increases and venous return to the heart is impeded.
B) Intrathoracic pressure increases and venous return to the heart is facilitated.
C) Intrathoracic pressure decreases and venous return to the heart is impeded.
D) Intrathoracic pressure decreases and venous return to the heart is facilitated.
intrathoracic pressure decreases and venous return to the heart is facilitated
The trachea divides into the right and left mainstem bronchi at the: A) carina. B) hilum. C) lingual. D) thoracic inlet.
carina
Which of the following has the greatest likelihood of resulting in an open pneumothorax?
A) Any opening between the pleural cavity and the atmosphere
B) Open defects that are two-thirds the size of the trachea or larger
C) Open defects that are larger in diameter than the trachea
D) Open defects that are one-quarter the size of the trachea or larger
open defects that are two thirds the size of the trachea or larger
) Your patient is a 38-year-old man who was pinned beneath the frame of a vehicle when it
slipped off the makeshift jacks he was using to elevate it. The patient’s brother thinks he may
have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the
vehicle off the patient. Which of the following medications could you consider giving this
patient?
A) Magnesium sulfate
B) Calcium chloride
C) Sodium bicarbonate
D) Potassium chloride
sodium bicarbonate
Your patient is a 27-year-old man with one stab wound at the fifth intercostal space
posteriorly, on the right. He is ambulatory at the scene, but dyspneic and has air movement at the
site of the injury. Which of the following should you do first?
A) Apply oxygen by nonrebreather.
B) Cover the wound with your gloved hand.
C) Prepare an occlusive dressing.
D) Perform a needle thoracostomy.
prepare an occlusive dressing
Which of the following statements is NOT true of pericardial tamponade?
A) It is most often associated with penetrating trauma.
B) The systolic blood pressure increases significantly on inspiration.
C) As little as 150 mL of blood can cause pericardial tamponade.
D) The pathophysiology results in increased venous pressure and decreased cardiac output.
the systolic blood pressure increases significantly on inspiration
) Which of the following statements concerning blunt thoracic trauma in the pediatric
population is most accurate?
A) Children are more likely than adults to suffer both rib fracture and organ injury.
B) Children are less likely than adults to suffer either rib fractures or organ injury.
C) Children are more likely than adults to suffer rib fractures but less likely to suffer significant
organ injury.
D) Children are less likely than adults to suffer rib fractures but more likely to have significant
organ injury
children are less likely than adults to suffer rib fractures but more likely to have significant organ injury
An individual is struck in the left ventricle with a low-velocity projectile. As compared to
high-velocity penetrating trauma, you should have a higher index of suspicion for:
A) ventricular rupture.
B) pericardial tamponade.
C) simple penetrating injury.
D) blunt cardiac injury.
pericardial tamponade
Your patient received a blow to the left lateral chest at the level of the sixth and seventh ribs.
You should suspect fractures at:
A) the point of impact of the sixth rib only.
B) the point of impact and the posterior axillary line of the sixth rib only.
C) the point of impact on both ribs.
D) the point of impact and the posterior axillary line of both ribs.
the point of impact and the posterior axillary line of both ribs
You have arrived on the scene of a paramedic who was shot as she approached a residence on
a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot
wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is
pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and
difficulty breathing. The patient’s EMT partner has applied oxygen by nonrebreather mask and
placed an occlusive dressing over the entry wound before your arrival. As you continue your
assessment, the patient’s level of consciousness decreases. She responds to verbal stimuli. Her
airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her
breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is
non-guarded and non-tender. Which of the following best explains the presentation of this
patient?
A) Simple pneumothorax
B) Tension pneumothorax
C) Pericardial tamponade
D) Hemothorax
hemothorax
You have arrived on the scene of a paramedic who was shot as she approached a residence on
a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot
wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is
pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and
difficulty breathing. The patient’s EMT partner has applied oxygen by nonrebreathing mask and
placed an occlusive dressing over the entry wound before your arrival. As you continue your
assessment, the patient’s level of consciousness decreases. She responds to verbal stimuli. Her
airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her
breath sounds are absent on the left side. The patient lacks a radial pulse, and the abdomen is
non-guarded and non-tender. Which of the following should you do first?
A) Start a large-bore IV of isotonic crystalloid solution.
B) Do a rapid trauma assessment.
C) Assist ventilations with a bag-valve-mask device.
D) Do an immediate needle chest decompression.
assist ventilations with a bag valve mask device
) Which of the following is TRUE of pulmonary contusion?
A) Signs and symptoms generally develop gradually.
B) Pulmonary contusion is typically an isolated injury.
C) The primary pathophysiology is that the alveoli are filled with blood.
D) Pulmonary contusion results in paradoxical motion of the chest wall.
signs and symptoms generally develop gradually
Which of the following is the primary prehospital concern with a simple, isolated fracture of
the fifth rib in the right posterior—axillary line?
A) Hemorrhage
B) Pneumonia
C) Hypoventilation
D) Liver contusion
hypoventilation
Which of the following best describes the threat to life associated with traumatic rupture of
the esophagus?
A) Entry of gastric contents into the mediastinum
B) Hypoxia
C) Decreased cardiac output
D) Massive hemorrhage
entry of gastric contents into the mediastinum
Which of the following best describes the epidemiology of sternal fracture? A) Low incidence, low mortality B) High incidence, high mortality C) High incidence, low mortality D) Low incidence, high mortality
low incidence, high mortality
Abdominal trauma should be suspected with penetrating thoracic wounds below the
________ rib anteriorly and the ________ rib posteriorly.
A) fourth; ninth
B) second; fifth
C) fourth; sixth
D) second; tenth
fourth, sixth
Your patient is an 80-year-old man who was the unrestrained driver of a vehicle without
airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he
is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There
are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the
sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest
excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the
following is most needed in this patient?
A) Infusion of isotonic crystalloid solution using a large-bore IV
B) Application of bulky dressings over the site of paradoxical motion
C) Being placed in a prone position to stabilize the chest wall
D) Intubation and positive-pressure ventilation
intubation and positive pressure ventilation
) Traumatic asphyxia is a(n) \_\_\_\_\_\_\_\_ type of injury. A) compression B) deceleration C) decompression D) acceleration
compression
Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma? A) Pulmonary contusion B) Atelectasis C) Exacerbation of flail chest D) Impaired venous return to the heart
impaired venous return to the heart
Which of the following most accurately characterizes simple pneumothorax?
A) Untreated, it will lead to mediastinal shift and compression of the contralateral lung.
B) It is a problem of ventilation—perfusion mismatch.
C) It results from air entering the pleural cavity through a defect in the chest wall.
D) It results from the creation of a one-way valve that continues to allow air into, but not out of,
the pleural cavity.
it is a problem of ventilation - perfusion mismatch
) Which of the following findings differentiates a simple pneumothorax from a tension
pneumothorax?
A) Decreased breath sounds on the affected side
B) Hemodynamic compromise
C) Absent breath sounds on the affected side
D) An open defect in the chest wall
hemodynamic compromise
