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Questions and Answers
When a person is lying supine at the end of exhalation, where may the diaphragm rise as high as?
When a person is lying supine at the end of exhalation, where may the diaphragm rise as high as?
the nipple line
What is MOST likely causing this patient's deterioration: compression of the aorta and vena cava?
What is MOST likely causing this patient's deterioration: compression of the aorta and vena cava?
compression of the aorta and vena cava
Common signs and symptoms of a chest injury include all of the following, EXCEPT:
Common signs and symptoms of a chest injury include all of the following, EXCEPT:
- Crepitus with palpation of the chest
- Bruising of the chest wall
- Unequal expansion of the chest wall
- Clear and equal breath sounds (correct)
Which of the following organs or structures does NOT reside within the mediastinum?
Which of the following organs or structures does NOT reside within the mediastinum?
What should you do when a patient is experiencing increasing respiratory distress and tachycardia after an open chest wound has been sealed?
What should you do when a patient is experiencing increasing respiratory distress and tachycardia after an open chest wound has been sealed?
The MOST critical treatment for a tension pneumothorax involves:
The MOST critical treatment for a tension pneumothorax involves:
Pleural fluid is contained between the:
Pleural fluid is contained between the:
The thoracic cavity is separated from the abdominal cavity by the:
The thoracic cavity is separated from the abdominal cavity by the:
To avoid exacerbating a patient's pneumothorax, what should you use extreme caution with?
To avoid exacerbating a patient's pneumothorax, what should you use extreme caution with?
What should you provide for an 18-year-old female presenting with respiratory distress and signs of shock after blunt chest trauma?
What should you provide for an 18-year-old female presenting with respiratory distress and signs of shock after blunt chest trauma?
Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:
Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:
The phrenic nerves control the diaphragm and exit the spinal cord at:
The phrenic nerves control the diaphragm and exit the spinal cord at:
A patient who presents with profound cyanosis following a chest injury:
A patient who presents with profound cyanosis following a chest injury:
If paradoxical movement of a chest wall is noted, what should you do?
If paradoxical movement of a chest wall is noted, what should you do?
Elevation of the rib cage during inhalation occurs when:
Elevation of the rib cage during inhalation occurs when:
What likely occurred if a 19-year-old male is unresponsive, apneic, and pulseless after being struck in the chest?
What likely occurred if a 19-year-old male is unresponsive, apneic, and pulseless after being struck in the chest?
If a person's tidal volume decreases, but respiratory rate remains unchanged:
If a person's tidal volume decreases, but respiratory rate remains unchanged:
Hemoptysis is defined as:
Hemoptysis is defined as:
After a baseball bat injury, what should you prepare for if the patient has severe chest pain and rapid irregular pulse?
After a baseball bat injury, what should you prepare for if the patient has severe chest pain and rapid irregular pulse?
What should you be MOST suspicious of for an unconscious, tachycardic, and diaphoretic female who wasn't wearing a seatbelt after a crash?
What should you be MOST suspicious of for an unconscious, tachycardic, and diaphoretic female who wasn't wearing a seatbelt after a crash?
What occurs when there is irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation?
What occurs when there is irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation?
Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:
Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:
Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:
Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:
The ________ nerves control the diaphragm.
The ________ nerves control the diaphragm.
What occurs when a patient's injury allows air to enter through a hole in the chest wall or lung surface, causing the lung to collapse?
What occurs when a patient's injury allows air to enter through a hole in the chest wall or lung surface, causing the lung to collapse?
An open pneumothorax occurs when:
An open pneumothorax occurs when:
Upon finding a patient with severe labored breathing and a large bruise to the chest, what should you immediately request?
Upon finding a patient with severe labored breathing and a large bruise to the chest, what should you immediately request?
Why are children often 'belly breathers'?
Why are children often 'belly breathers'?
What is the most likely condition for a patient holding the lateral side of his chest with rapid and shallow respirations?
What is the most likely condition for a patient holding the lateral side of his chest with rapid and shallow respirations?
What should you administer and transport to the hospital for a patient with diminished breath sounds and stable vital signs?
What should you administer and transport to the hospital for a patient with diminished breath sounds and stable vital signs?
Following an injury from a truck, what should you suspect with bruising to the chest and distended neck veins?
Following an injury from a truck, what should you suspect with bruising to the chest and distended neck veins?
Which assessment findings should increase your suspicion for a cardiac tamponade?
Which assessment findings should increase your suspicion for a cardiac tamponade?
A spinal cord injury at the level of C7 would MOST likely result in:
A spinal cord injury at the level of C7 would MOST likely result in:
Patients with chest injuries will often present with:
Patients with chest injuries will often present with:
What should you suspect if the patient has a flail segment to the right side of the chest after 12 hours?
What should you suspect if the patient has a flail segment to the right side of the chest after 12 hours?
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Study Notes
Chest Injuries Overview
- Diaphragm can rise to the nipple line when a person is supine at the end of exhalation.
- Compression of the aorta and vena cava is the likely cause of deterioration in a stable patient with a pneumothorax.
- Common signs of chest injuries include respiratory distress and tachycardia; hematemesis is not typical.
- Lungs do not reside within the mediastinum, which contains structures like the heart and great vessels.
Management of Chest Wounds
- If a sealed open chest wound leads to increased respiratory distress, partially removing the dressing is necessary.
- Tension pneumothorax requires urgent intervention by inserting a needle into the pleural space.
- Pleural fluid is found between the visceral and parietal pleurae, allowing for smooth lung movement.
Respiratory Mechanics
- Thoracic cavity is separated from the abdominal cavity by the diaphragm.
- Positive-pressure ventilation can exacerbate pneumothorax injuries.
- Increased respiratory rate is needed if tidal volume decreases to maintain minute volume.
Injury Mechanisms and Symptoms
- Blunt chest trauma can lead to immediate death from traumatic aortic rupture.
- Phrenic nerves control the diaphragm, originating from spinal cord segments C3, C4, and C5.
- Patients presenting with profound cyanosis post-chest injury require immediate ventilation and oxygenation.
Specific Conditions and Signs
- Paradoxical movement in blunt chest trauma indicates a need for chest wall stabilization.
- Flail chest involves a segment of the chest wall that is detached and typically results from rib fractures.
- Myocardial contusion indicated by a rapid, irregular pulse after blunt chest trauma.
Pneumothorax and Tamponade
- Simple pneumothorax is common with blunt trauma; open pneumothorax occurs when air enters the pleural space from the outside.
- Cardiac tamponade manifests with engorged jugular veins and could develop after penetrating chest trauma.
Pediatric Considerations
- Children may be "belly breathers" due to underdeveloped intercostal muscles.
Key Assessment Indicators
- Clear and equal breath sounds are a normal finding and not indicative of injury.
- A rapid assessment for life-threatening injuries is crucial during the primary assessment.
- Pulmonary contusion suspected with a flail segment and respiratory distress despite equal breath sounds.
Additional Assessment Findings
- A patient with a history of blunt trauma showing distended neck veins, diminished breath sounds, and bruising suggests severe hemopneumothorax.
- A spinal cord injury at the C7 level primarily results in intercostal muscle paralysis without affecting diaphragm function.
Summary of Signs
- Tachypnea is a common presentation in patients with chest injuries.
- Hemoptysis, defined as coughing up blood, can occur due to various chest injuries or lung involvement.
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