Chapter 30 Workbook

Question 1

Delivering oxygen to the blood by diffusion

Answer 1

Oxygenation

Question 2

The chest

Answer 2

Thoracic cage

Question 3

The center cavity of the thorax

Answer 3

Mediastinum

Question 4

Separates the chest from the abdomen

Answer 4

Diaphragm

Question 5

One of the great vessels in the chest; the main artery in the chest

Answer 5

Aorta

Question 6

Usually caused by a penetrating wound

Answer 6

Open chest injury

Question 7

Rapid respirations

Answer 7

Tachypnea

Question 8

Usually caused by blunt trauma

Answer 8

Closed chest injury

Question 9

Coughing up blood

Answer 9

Hemoptysis

Question 10

The protective membrane around the heart

Answer 10

Pericardium

Question 11

Moving air in and out of the lungs

Answer 11

Ventilation

Question 12

Air is supplied to the lungs via the:
A. esophagus
B. trachea
C. nares
D. oropharynx

Answer 12

B. trachea

Question 13

The __________ separates the thoracic cavity from the abdominal cavity.
A. diaphragm
B. mediastinum
C. xyphoid process
D. inferior border of the ribs

Answer 13

A. diaphragm

Question 14

On inhalation, which of the following does NOT occur:
A. The intercostal muscles contract, elevating the rib cage.
B. The diaphragm contracts.
C. The pressure inside the chest increases.
D. Air enters through the nose and mouth.

Answer 14

C. The pressure inside the chest increases.

Question 15

You respond to the local rodeo arena for a bull rider. The scene is safe, and the patient is lying unconscious in the middle of the arena. His airway is open, and he is breathing at 20 breaths per minute. His pulse is 128 beats per minute, and his blood pressure is 110/64 mm Hg. There is no obvious bleeding. Bystanders tell you that he was thrown into the air and landed on the bull’s head. He was not wearing a vest. Which of the following injuries is not blunt trauma to the chest:
A. Bruising of the lungs and heart
B. Fracture of whole areas of the chest wall
C. Damage to the aorta
D. Dissection of the carotid arteries

Answer 15

D. Dissection of the carotid arteries

Question 16

You respond to a motor vehicle collision and find a 29-year-old woman who is complaining of chest pain. Her chest struck the steering wheel. Her airway is open, she is breathing at 24 breaths per minute, and she is coughing up blood. Her pulse is 130 beats per minute, rapid and weak, and her blood pressure is 90/58 mm Hg. You notice cyanosis around the lips and note that her fingers are also blue. When you expose the chest, she tells you that it hurts when she takes a breath and points to a bruised spot. Which of the following is a symptom of her chest injury:
A. Cyanosis around the lips or fingertips
B. Rapid, weak pulse
C. Hemoptysis
D. Pain at the bruised site

Answer 16

D. Pain at the bruised site

Question 17

Which of the following is not a sign or symptom of a chest injury:
A. Bruising of the chest wall
B. Crepitus with palpation of the chest
C. Clear and equal breath sounds
D. Unequal expansion of the chest wall

Answer 17

C. Clear and equal breath sounds

Question 18

You respond to an 18-year-old man who has been assaulted with a baseball bat. He was hit once in the chest. He is unresponsive, apneic, and pulseless. This condition is most likely related to:
A. Commotio cordis
B. Cardiac tamponade
C. Pneumothorax
D. Traumatic asphyxia

Answer 18

A. Commotio cordis

Question 19

Paradoxical motion of the chest refers to:
A. Rib fractures that move with the chest wall during breathing
B. One segment of the chest wall moving opposite the remainder of the chest
C. Unequal expansion of the chest wall
D. One segment of the chest wall moving out on inspiration and in on exhalation

Answer 19

B. One segment of the chest wall moving opposite the remainder of the chest

Question 20

A ________ results when an injury allows air to enter through a hole in the chest wall or the surface of the lung as the patient attempts to breathe, causing the lung on that side to collapse:
A. Tension pneumothorax
B. Hemothorax
C. Hemopneumothorax
D. Pneumothorax

Answer 20

D. Pneumothorax

Question 21

A sucking chest wound should be treated with:
A. A standard dressing
B. Taping down of the chest
C. An occlusive dressing
D. A sandbag over the wound

Answer 21

C. An occlusive dressing

Question 22

You respond to a 20-year-old man who was playing basketball and suddenly developed chest pain and respiratory difficulty. He is alert and oriented and complaining of chest pain. He is breathing at 24 breaths per minute. His pulse is 140 beats per minute, and his blood pressure is 160/90 mm Hg. When listening to the chest, you notice diminished breath sounds on the left side. This patient is most likely suffering from a(n):
A. Simple pneumothorax
B. Hemothorax
C. Tension pneumothorax
D. Open pneumothorax

Answer 22

A. Simple pneumothorax

Question 23

Distended jugular veins, a narrowing pulse pressure, and muffled heart sounds are seen in which of the following conditions:
A. Tension pneumothorax
B. Cardiac tamponade
C. Traumatic asphyxia
D. Commotio cordis

Answer 23

B. Cardiac tamponade

Question 24

Common signs and symptoms of tension pneumothorax include all of the following except:
A. Increasing respiratory distress
B. Distended neck veins
C. High blood pressure
D. Tracheal deviation away from the injured site

Answer 24

C. High blood pressure

Question 25

Which of the following statements regarding hemothorax is correct: A. It can only be treated by a surgeon. B. It results from a collection of air in the pleural space. C. Breath sounds tend to be equal. D. It is not typically associated with shock.

Answer 25

A. It can only be treated by a surgeon.

Question 26

A __________ is the result of blunt chest trauma and is associated with an irregular pulse and sometimes dangerous cardiac rhythms: A. Cardiac tamponade B. Pulmonary contusion C. Myocardial contusion D. Traumatic asphyxia

Answer 26

C. Myocardial contusion

Question 27

A patient with blunt trauma who is holding the lateral side of his chest and has rapid and shallow respirations is most likely suffering from: A. Rib fractures B. A sternal fracture C. A pneumothorax D. A pulmonary contusion

Answer 27

A. Rib fractures

Question 28

Traumatic asphyxia: A. Is bruising of the lung B. Occurs when three or more adjacent ribs are fractured in two or more places C. Is a sudden, severe compression of the chest D. Results from the pericardial sac filling with blood

Answer 28

C. Is a sudden, severe compression of the chest

Question 29

__________ can increase intrathoracic pressure, reducing cardiac output and potentially worsening chest injuries such as pneumothorax: A. Hypoventilation B. Positive pressure ventilation C. Hyperventilation D. Overventilation

Answer 29

D. Overventilation

Question 30

Which of the following is not a pertinent negative to note during your assessment of a patient with chest trauma: A. No heart murmurs B. No associated shortness of breath C. No rapid breathing D. No areas of deformity

Answer 30

A. No heart murmurs

Question 31

Large blood vessels in the chest that can result in massive hemorrhaging include all of the following except: A. The pulmonary arteries B. The femoral arteries C. The aorta D. The four main pulmonary veins

Answer 31

B. The femoral arteries

Question 32

Dyspnea is difficulty breathing.

Answer 32

True

Question 33

Tachypnea is slow respirations.

Answer 33

False

Question 34

Distended neck veins may be a sign of a tension pneumothorax.

Answer 34

True

Question 35

Rib fractures are especially common in children.

Answer 35

False

Question 36

Narrowing pulse pressure is related to spontaneous pneumothorax.

Answer 36

False

Question 37

Laceration of the large blood vessels in the chest can cause minimal hemorrhage.

Answer 37

False

Question 38

The thoracic cage extends from the lower end of the neck to the umbilicus.

Answer 38

False

Question 39

Patients with spinal cord injuries at C3 or above can lose their ability to breathe.

Answer 39

True

Question 40

A flutter valve is a three-way valve that allows air to leave the chest cavity.

Answer 40

False

Question 41

Open chest injury is caused by penetrating trauma.

Answer 41

True

Question 42

Paradoxical motion can be a sign of a flail segment.

Answer 42

True

Question 43

Because patients with a chest injury have so many risks of mortality, they should be reassessed every 10 minutes.

Answer 43

False

Question 44

You should control external bleeding with direct pressure and a bulky dressing.

Answer 44

True

Question 45

Almost one-third of people who are killed immediately in car crashes die as a result of traumatic rupture of the aorta.

Answer 45

True

Question 46

The right lung contains two lobes, and the left lung contains three lobes.

Answer 46

False

Question 47

The esophagus is located in the __________ of the chest.

Answer 47

back

Question 48

During inhalation, the pressure in the chest __________.

Answer 48

decreases

Question 49

In the anterior chest, ribs connect to the __________.

Answer 49

sternum

Question 50

The trachea divides into the right and left mainstem __________.

Answer 50

bronchi

Question 51

The __________ nerves supply the diaphragm.

Answer 51

phrenic

Question 52

Contents of the chest are protected by the ____________.

Answer 52

ribs

Question 53

The chest extends from the lower end of the neck to the ____________.

Answer 53

diaphragm

Question 54

____________ line the area between the lungs and chest wall.

Answer 54

Pleura

Question 55

An increase in CO₂ in the blood is known as ____________.

Answer 55

hyoercarbia

Question 56

During inhalation, the diaphragm ____________.

Answer 56

contracts

Question 57

____________ is the body’s ability to move air in and out of the chest and lung tissue.

Answer 57

Ventilation

Question 58

The intercostal muscles are innervated from spinal nerves originating in the lower ____________ and upper ____________ regions of the spinal cord.

Answer 58

C6, C7

Question 59

____________ ____________ is the amount of air in mL that is moved into or out of the lungs during a single breath.

Answer 59

Tidal volume

Question 60

The ____________ ____________ may drop as the brain becomes starved for oxygen and overloaded with carbon dioxide and other waste products.

Answer 60

respiratory rate

Question 61

A severing of the aorta can occur when the body is exposed to ____________ ____________.

Answer 61

traumatic forces

Question 62

Answer 62

Anterior Aspect of the Chest A. Subclavian artery B. Superior vena cava C. Heart D. Aorta E. Pulmonary arteries F. Pleural lining G. Lungs H. Diaphragm

Question 63

Answer 63

Pneumothorax A. Parietal pleura B. Air in the pleural space C. Wound site D. Lung E. Collapsed lung F. Heart G. Visceral pleura H. Diaphragm

Question 64

Short Answers List the signs and symptoms associated with a chest injury.

Answer 64

* Pain at the site of injury * Pain localized at the site of injury that is aggravated by or increased with breathing * Bruising to the chest wall * Crepitus with palpation of the chest * Any penetrating injury to the chest * Dyspnea (difficulty breathing, shortness of breath) * Hemoptysis (coughing up blood) * Failure of one or both sides of the chest to expand normally with inspiration * Rapid, weak pulse and low blood pressure * Cyanosis around the lips or fingernails

Question 65

Short Answers Describe the two methods for sealing a sucking chest wound.

Answer 65

1. Seal the wound with a large airtight dressing that seals all four sides. 2. Seal the wound with a dressing that seals three sides, with the fourth side as a flutter valve. Local protocol determines which method is used.

Question 66

Short Answers Describe the method(s) for treating a flail chest segment.

Answer 66

Maintain the airway, provide respiratory support if necessary, and give supplemental oxygen. Perform an ongoing assessment for possible pneumothorax or other respiratory complications. Provide positive pressure ventilation with a bag-mask device as needed. Use PPV in place of splinting with a bulky dressing.

Question 67

Short Answers Define traumatic asphyxia and describe its signs.

Answer 67

Sudden severe compression of the chest, causing a rapid increase of pressure within the chest. Characteristic signs include distended neck veins, facial and neck cyanosis, and hemorrhage in the sclera of the eye.

Question 68

Short Answers List the “deadly dozen” chest injuries.

Answer 68

1. Airway obstruction 2. Bronchial disruption 3. Diaphragmatic tear 4. Esophageal injury 5. Open pneumothorax 6. Tension pneumothorax 7. Massive hemothorax 8. Flail chest 9. Cardiac tamponade 10. Thoracic aortic dissection 11. Myocardial contusion 12. Pulmonary contusion

Question 69

Ambulance Calls You are dispatched to an area horse ranch for an injury to a rider. You arrive to find that a horse has kicked one of the riders in the chest. The patient is having significant difficulty breathing and appears to be in extreme pain. How would you best manage this patient?

Answer 69

You should be concerned with the presence of rib and sternal fractures as well as pulmonary contusions and pneumothoraces. This patient may require assistance in breathing because it will be extremely painful for him to breathe in. If he requires assistance with a bag-mask device, you must be careful not to become too aggressive in your ventilations. Time your ventilations with the patient’s respirations and be gentle. Provide high flow oxygen and take spinal precautions according to your local protocols

Question 70

Ambulance Calls You are dispatched for a man trapped under a car. As you travel to the location, the dispatcher informs you that your patient is now free but is experiencing significant chest and midback pain. How would you best manage this patient?

Answer 70

This patient’s chest has been crushed with a significant amount of weight. This mechanism of injury indicates the high potential for rib, sternal, and thoracic fractures as well as other soft tissue injuries. Patients who experience sternal fractures will find it difficult to be placed supine because this will likely increase their pain. There will be little you can do to ease this pain because the patient should be immobilized on a long backboard. Provide prompt transport and high flow oxygen, and monitor the pulse, motor, and sensations, particularly distal to the suspected spinal injury.

Question 71

Ambulance Calls You are dispatched to a lumberyard where a 27-year-old man was crushed by a piece of heavy equipment. Coworkers pulled the equipment off the patient. He presents with distended neck veins, cyanosis, and bloodshot eyes. How would you best manage this patient?

Answer 71

Apply high‑flow oxygen via a nonrebreathing mask or a bag‑mask device. Provide full cervical spine immobilization. Provide rapid transport and monitor vital signs en route.

Question 72

You respond to an accidental shooting of a 37 year old man. During the primary assessment, you find his airway to be open. His breathing is labored at 24 breaths per minute. His pulse is rapid and weak. When exposing the chest, you find a sucking chest wound. Your first priority in caring for this patient should be to: A. Take a blood pressure reading B. Seal the wound with an appropriate dressing C. Continue your assessment D. Transport the patient immediately

Answer 72

B. Seal the wound with an appropriate dressing

Question 73

You respond to a 17 year old girl who was hit in the chest with a lawn dart. On arrival, she is conscious and able to converse with you. Her airway is open, but her breathing is becoming progressively more difficult. Her pulse is rapid and weak. You can palpate a radial pulse. On examining the chest, you find that she has a penetrating injury to the chest and that there is a sucking sound as she breathes. How do you manage this wound: A. Apply oxygen by nasal cannula B. Stabilize the cervical spine C. Use a 4 inch by 4 inch gauze pad D. Use an occlusive dressing

Answer 73

D. Use an occlusive dressing

Question 74

When bandaging an open chest wound, what is the minimum number of sides that have to be taped down: A. One B. Two C. Three D. Four

Answer 74

C. Three

Question 75

Dispatch sends you to a farm on the edge of town. A 57 year old man was kicked in the chest by a horse. He walked into his house and collapsed. He is confused and lethargic. His breathing is labored at 28 breaths per minute, pulse is rapid and regular, and you are able to palpate a radial pulse. On examining his chest, you notice paradoxical movement on the right chest wall. You should: A. Provide spinal immobilization B. Put the patient in a position of comfort C. Provide oxygen by nasal cannula D. Provide positive pressure ventilations

Answer 75

D. Provide positive pressure ventilations

Question 76

A 16 year old boy walked into a pipe gate that hit him in the ribs on the left side. On arrival, he is alert and oriented. His breathing is shallow at 22 breaths per minute. His pulse is regular and strong. You palpate a radial pulse. You are able to rule out spinal trauma. In which position do you transport him: A. Position of comfort B. Supine C. Prone D. Recovery

Answer 76

A. Position of comfort