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Exam 7: Chest Trauma

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Question 1

Multiple Choice

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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

Correct Answer

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C

Question 2

Multiple Choice

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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.

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Question 3

Multiple Choice

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Which of the following is TRUE of pulmonary contusion?

Which of the following has the greatest likelihood of resulting in an open pneumothorax?

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?

The location of the neurovascular bundles containing the intercostal arteries is best described as the bundle that runs along the:

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?

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?

Which of the following is the primary concern in the patient with a hemothorax?

Which of the following is the correct description of a wound that is below the fifth rib, directly in line with the armpit?

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?

Hemothorax is primarily a problem of:

Your patient is a 15-year-old male who was struck in the chest with a baseball. He is unresponsive, pulseless, and apneic. The monitor shows ventricular fibrillation. This condition is most accurately described as:

Which of the following best describes the mechanism of blunt thoracic trauma associated with blast injuries?

Which of the following are the most commonly fractured ribs?

Your patient was the unrestrained driver of a motor vehicle without airbags. The vehicle struck a large utility pole at about 45 miles per hour. Your patient has a contusion over his chest and upper abdomen consistent with the shape of the steering wheel. You should suspect which of the following types of injury in this patient?

The trachea divides into the right and left mainstem bronchi at the:

Which of the following best describes the incidence of pericardial tamponade?

The central area in the thorax that contains the heart, great vessels, trachea, and esophagus is the:

Your patient is a 21-year-old man with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route, the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should: