MOD6 – Chapter 29 – Chest and Abdominal trauma

Which of the following is a true statement regarding the skin’s status in the case of a closed chest injury?

Internal contusions and lacerations cannot occur.
The skin may be penetrated and occluded.
The skin is penetrated.
The skin is not penetrated.

The skin is not penetrated.
Which of the following is a strategy to maintain an occlusive dressing to bloody or diaphoretic skin?

Do not use occlusive dressings in this case.
Manually maintain pressure.
Do not use adhesive tape.
Wrap the dressing circumferentially with gauze.

Manually maintain pressure.
Some drawbacks to using sterile aluminum foil as an occlusive dressing include:

sterility cannot be ensured unless the materials were autoclaved.
a flutter valve is difficult to create.
foil cannot create an airtight seal.
skin lacerations may occur from the sharp edges.

skin lacerations may occur from the sharp edges.
Which of the following is required in the management of all open soft-tissue injuries?

Provision of high-concentration oxygen to the patient
The use of Standard Precautions by the EMT
Cervical spine precautions
Application of a disinfectant solution during clean-up

The use of Standard Precautions by the EMT
In addition to lacerations, blunt trauma resulting in a closed chest injury creates the potential for which of the following internal injuries?

Abrasion
Contusion
Evisceration
Avulsion

Contusion
You are dispatched to a 42-year-old male who was shot in the abdomen and thrown from a vehicle. The patient is critical and a high-category trauma; however, due to the mechanism of illness, it is necessary to backboard the patient prior to transport. What is an important assessment before securing the patient?

Verifying trauma center ER bed availability
Examining the patient for entrance and exit wounds
Searching for presence of diaphoresis, tachycardia, and hypotension
Performing a distal neurological assessment

Examining the patient for entrance and exit wounds
Which of the following is a vascular organ in the abdomen that can produce blood loss quickly enough to result in life-threatening hemorrhage following high mechanism of injury blunt trauma?

Intestines
Liver
Pancreas
Kidneys

Liver
You’re an off-duty EMT who encounters a patient sitting behind the wheel of a vehicle that ran off the road along an isolated county road. It appears the patient was unrestrained, or not wearing a seat belt, and struck the steering wheel with his chest. On assessment, you notice a paradoxical motion to the patient’s chest on inspiration and expiration. When you radio for dispatch of an ambulance, which of the following pieces of information would you be sure to include?

The patient may have an abdominal evisceration.
The patient is showing signs of abdominal bleeding.
The patient is showing signs of an open chest injury.
The patient may have a flail chest.

The patient may have a flail chest.
Which of the following BEST describes an evisceration?

An open wound of the abdomen from which organs protrude
A flap of skin that is partially or completely torn away from the underlying tissue
An accumulation of blood beneath the skin, resulting in swelling
The epidermis that is scraped away by a rough surface

An open wound of the abdomen from which organs protrude
Bleeding from open abdominal injuries should initially be controlled with which one of the following techniques?

Packing the wound with rolled gauze
Applying an occlusive dressing
Applying direct pressure to the wound
Applying an ice pack or chemical cold pack

Applying direct pressure to the wound
Which of the following is NOT an open tissue injury?

Contusion
Evisceration
Avulsion
Abrasion

Contusion
A 36-year-old male was accidentally shot with a nail gun into the chest. You see the nail, which protrudes about 2 to 3 centimeters from the thorax, when you visualize the injury site. Under which of the following circumstances should you remove the nail from the injury site?
Answer Bleeding from the patient’s wound is minimal.
The patient develops a tension pneumothorax.
The patient begins to complain of shortness of breath.
None of the above
None of the above
Which of the following injuries does NOT produce distended neck veins?

Traumatic asphyxia
Tension pneumothorax
Cardiac tamponade
All of the answer choices may cause distended neck veins.

All of the answer choices may cause distended neck veins.
Which of the following injuries requires the use of an occlusive dressing?

An open wound to the chest
An open wound to the neck
An open wound to the abdomen from which a loop of intestine is protruding
All of the above

All of the above
Which of the following is an unreliable sign for determining the presence of a tension pneumothorax?
Answer Distended neck veins
Signs and symptoms of shock
Shortness of breath
Trachea that shifts to the side opposite the injury
Trachea that shifts to the side opposite the injury
Which of the following describes the proper application of an occlusive dressing for an open chest wound?

Trim the dressing so that it is the exact size of the wound.
Use a porous material such as a 4″ by 4″ gauze pad.
Tape the dressing securely on three sides.
None of the above

Tape the dressing securely on three sides.
For which of the following wounds should the EMT apply an absorbent dressing moistened with sterile saline and then cover it with an occlusive dressing?

A gunshot wound to the abdomen from which a loop of intestine is protruding
A stab wound to the chest
A laceration to the neck
The stump of an amputated extremity

A gunshot wound to the abdomen from which a loop of intestine is protruding
The pathophysiology of _________ is one in which the pericardial sac fills with blood to the point where the chambers of the heart no longer fill adequately, usually secondary to trauma.

pericardial effusion
hemopneumothorax
cardiac tamponade
commotio cordis

cardiac tamponade
Which of the following traumatic chest injuries may result in massive, often fatal internal hemorrhage?

Hemopneumothorax
Hemothorax
Aortic dissection
Cardiac tamponade

Aortic dissection
You are on an EMS standby for a boxing tournament. During one of the matches, one of the female boxers delivers a forcible uppercut to the chest of her opponent, who falls to the ground. The match is declared over on the basis of a TKO. However, the opponent fails to arise following a 1-2 minute interval. EMS is summoned to the ring. You find the patient pulseless and breathing agonal gasps. You suspect which of the following traumatic conditions?

Cardiac tamponade
Aortic dissection
Tension pneumothorax
Commotio cordis

Commotio cordis
While palpating the radial pulses of a patient who was involved in a motor vehicle crash, you notice a difference in the strength of the pulses bilaterally. This is a finding that you suspect may be associated with:

aortic dissection.
tension pneumothorax.
commotio cordis.
flail chest.

aortic dissection.
Common signs and symptoms following an injury to a hollow abdominal organ include:

increasing intrathoracic pressures.
irritation and peritonitis.
massive hemorrhage.
absence of unilateral pulses.

irritation and peritonitis.
Which of the following patients is at greatest risk of respiratory failure and should be carefully monitored for ventilatory status throughout treatment and transport?

Tension pneumothorax
Flail chest
Abdominal evisceration
Hemopneumothorax

Tension pneumothorax
Which of the following types of bandages should NOT be used by the EMT providing wound care?

Self-adherent roller gauze
Tourniquet
A triangular bandage
Adhesive tape

Tourniquet
Which of the following is a desirable characteristic of dressings used in the prehospital management of most open wounds?

Nonabsorbent
Sterile
Occlusive
Adherent

Sterile
You are caring for a 27-year-old male who has a puncture wound to the right upper chest. The patient was stabbed with a serrated steak knife by his ex-girlfriend. You have placed an occlusive dressing to the site and began emergent transport to the closest trauma center. However, while en route the patient begins to complain of increasing shortness of breath. You notice a decrease in ventilatory volume and an increase in thoracic diameter. Which of the following options would be the best step to perform next?

Free a corner or edge of the dressing to release pressure buildup.
Begin providing BVM-assisted ventilations to the patient.
Call dispatch for an ALS intercept en route to the hospital.
Begin providing CPR to the patient.

Free a corner or edge of the dressing to release pressure buildup.
Your patient is a 55-year-old male who was found in the parking lot behind a tavern. He states that he was assaulted and robbed by three individuals. He is complaining of being “hit in the face and kicked and punched in his ribs and stomach.” Your examination reveals contusions and swelling around both eyes, bleeding from the nose, a laceration of his upper lip, and multiple contusions of the chest, abdomen, and flanks. Which of the following should cause the greatest concern regarding the prehospital care of this patient?

The presence of any defensive wounds the patient may have sustained
Getting a description of the assailants
The possibility of a pneumothorax
Reducing the swelling around his eyes by applying a cold pack

The possibility of a pneumothorax
Which of the following is NOT appropriate in caring for a patient with closed soft-tissue injuries and a significant mechanism of injury?

Treat for shock if you think there are internal injuries even if the patient’s vital signs are normal.
Anticipate vomiting.
Splint any swollen, deformed extremities.
All of the answer choices are appropriate.

All of the answer choices are appropriate.
Which of the following is true concerning lacerations?

They may be caused by blunt trauma.
They may be caused by penetrating trauma.
They may indicate deeper underlying tissue damage.
All of the above

All of the above
Which of the following is of concern with a puncture wound?

The object that remains impaled in the body
The strong possibility of contamination
Hidden internal bleeding with minimal external bleeding
All of the above

All of the above
Which of the following is an accurate definition of a flail chest?

A lung that has been punctured by a fractured rib, resulting in a buildup of air
A section of the chest wall that is unstable, leading to breathing problems
The fracture of one rib in two or more consecutive places
The fracture of at least four ribs in two or more places

A section of the chest wall that is unstable, leading to breathing problems
What is the underlying cause of bluish or reddish facial discoloration following a traumatic asphyxiation?

High pressure on the chest leads to blood being forced from the right atrium into the face and neck.
The patient has become hypoxic due to a chest injury and the finding suggests central cyanosis.
The physiological strain of the body results in a flushed appearance and increased risk of a hypertensive event.
Bluish or reddish facial discoloration is not associated with traumatic asphyxiation; a pale discoloration is usually present

High pressure on the chest leads to blood being forced from the right atrium into the face and neck.
On assessment of the midsection of a 32-year-old male who was struck by a car, you find an abdominal evisceration with several loops of his large intestine exposed. The abdomen appears to have a clean-cut laceration and the bleeding is controlled. Which of the following is the BEST approach toward managing the exposed intestines?

Moisten a sterile dressing with saline solution and cover the abdominal contents.
Gently replace the intestines after moistening with sterile saline solution.
Leave the abdominal contents in the place in which they were found and transport immediately.
Cover the abdomen with an occlusive dressing of aluminum foil.

Moisten a sterile dressing with saline solution and cover the abdominal contents.
Your patient is a 21-year-old male who has a gunshot wound to the chest. Which of the following is the highest priority in managing this patient?

Placing the patient in the shock position
Performing a rapid trauma assessment
Placing a pressure dressing over the wound to control bleeding
Placing an occlusive dressing over the wound

Placing an occlusive dressing over the wound
Which of the following BEST describes the benefit of a three-sided occlusive dressing over a four-sided occlusive dressing for an open chest wound?

It eliminates the need to continue monitoring the patient’s respiratory status.
It prevents the development of a hemothorax by allowing blood to escape.
It allows easy access for re-examination of the wound en route to the hospital.
It reduces the chances of developing a tension pneumothorax.

It reduces the chances of developing a tension pneumothorax.
The mechanism of injury in which a patient’s chest has struck an immovable object, such as a steering wheel, may most accurately be described as a:

blunt trauma injury.
compression injury.
penetrating injury.
coup contrecoup injury.

compression injury.
The chest cavity can hold up to ________ liter(s) in an adult, leading to the possibility of massive internal hemorrhage without any external blood loss.

3
5
0.5
1

3
You are stabilizing a patient who has just been stabbed in the chest to the right of the mediastinum. After placing the patient on supplemental oxygen, his shortness of breath resolves. You also cover the wound with an occlusive dressing. The patient is asymptomatic at the time you’re making the decision to transport. Which of the following BEST encapsulates the correct strategy for transport?

The patient does not necessarily need transport, so allow him to refuse if he wants.
Transport the patient emergently because of the high index of suspicion for a serious injury.
Begin transport non-emergently and upgrade if the patient’s condition deteriorates.
Transport the patient non-emergently because he’s complaint free.

Transport the patient emergently because of the high index of suspicion for a serious injury.
What is the correct terminology for a wound in which a vacuum has been created within the chest, drawing air into the thorax with each breath?

A sucking chest wound
A closed tension pneumothorax
An open chest wound
A gurgling chest wound

A sucking chest wound
A patient with jugular vein distention is most likely suffering from which of the following injuries?

Pneumothorax
Hemothorax
Hemopneumothorax
Tension pneumothorax

Tension pneumothorax
Your patient was working on a car when it fell off the jack and trapped him between the tire and ground. His face is very blue and his eyes are bloodshot. Which of the following has the patient most likely suffered?

Hemothorax
Traumatic asphyxia
Pneumothorax
Flail chest

Traumatic asphyxia