Chapter 27. EMT

When a person is lying supine at the end of exhalation, the diaphragm

may rise as high as the nipple line.

You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient’s deterioration?

compression of the aorta and vena cava

Common signs and symptoms of a chest injury include all of the following, EXCEPT:

hematemesis.

Which of the following organs or structures does NOT reside within the mediastinum?

lungs

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to applying 100% oxygen, you should:

prepare for immediate transport.

You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing.

The MOST critical treatment for a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space.

Pleural fluid is contained between the:

visceral and parietal pleurae.

The thoracic cavity is separated from the abdominal cavity by the

diaphragm.

In order to avoid exacerbating a patient’s injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:

pneumothorax.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

provide some form of positive-pressure ventilation

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of

traumatic aortic rupture.

The phrenic nerves control the diaphragm and exit the spinal cord at:

C3, C4, and C5.

A patient who presents with profound cyanosis following a chest injury:

requires prompt ventilation and oxygenation.

During your assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should:

stabilize the chest wall with a bulky dressing.

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred?

ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

If a person’s tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will decrease.

Hemoptysis is defined as:

coughing up blood.

Elevation of the rib cage during inhalation occurs when

the intercostal muscles contract.

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called

pleurisy.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

collapsed jugular veins.

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

traumatic aortic rupture

The ________ nerves control the diaphragm.

phrenic

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unconscious, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a

laceration of the aorta

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

must increase his or her respiratory rate to maintain adequate minute volume.

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

myocardial contusion.

A flail chest occurs when:

a segment of the chest wall is detached from the thoracic cage.

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should:

administer oxygen and transport to the hospital.

When assessing a patient with a hemothorax, you will MOST likely find:

signs and symptoms of shock.

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade?

engorged jugular veins

Subcutaneous emphysema is an indication that:

air is escaping into the chest wall from a damaged lung

Patients with rib fractures will commonly:

breathe rapidly and shallowly

You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should:

immediately request ALS support