Chest Injury Review Quiz

When the chest impacts the steering wheel during a motor vehicle crash with rapid deceleration, the resulting injury, which often kills patients, usually within seconds, is:

• a hemothorax.

• aortic shearing.

• a pneumothorax.

• a ruptured myocardium.

Answer explanation

Aortic shearing occurs when the aorta is torn due to rapid deceleration, often leading to fatal internal bleeding. This injury is particularly lethal in motor vehicle crashes, making it the correct answer.

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

• hemoptysis.

• increased pain with breathing.

• hematemesis

• asymmetrical chest movement.

Answer explanation

Hematemsis, or vomiting blood, is not a sign of a chest injury. The other options—hemoptysis, increased pain with breathing, and asymmetrical chest movement—are all indicative of potential chest trauma.

During your assessment of a patient who was stabbed, you see an open wound to the left anterior chest. Your MOST immediate action should be to:

• position the patient on the affected side.

• transport immediately.

• assess the patient for a tension pneumothorax.

• cover the wound with an occlusive dressing.

Answer explanation

Covering the wound with an occlusive dressing is crucial to prevent air from entering the chest cavity, which can lead to a tension pneumothorax. This action stabilizes the injury before further assessment or transport.

When caring for a patient with signs of a pneumothorax, your MOST immediate concern should be:

• hypovolemia.

• intrathoracic bleeding.

• ventilatory inadequacy.

• associated myocardial injury.

Answer explanation

In a pneumothorax, the most immediate concern is ventilatory inadequacy due to compromised lung function. Ensuring adequate ventilation is critical to prevent respiratory failure.

What purpose does a one-way “flutter valve” serve when used on a patient with an open pneumothorax?

• It prevents air escape from within the chest cavity.

• It allows a release of air trapped in the pleural space.

• It only prevents air from entering an open chest wound.

• It allows air to freely move in and out of the chest cavity.

Answer explanation

A one-way flutter valve allows air trapped in the pleural space to escape while preventing air from entering the chest cavity, thus helping to manage the pressure and improve breathing in a patient with an open pneumothorax.

Signs of a cardiac tamponade include all of the following, EXCEPT:

• muffled heart tones.

• a weak, rapid pulse.

• collapsed jugular veins.

• narrowing pulse pressure.

Answer explanation

Collapsed jugular veins are not a sign of cardiac tamponade. Instead, signs include muffled heart tones, a weak rapid pulse, and narrowing pulse pressure, which indicate fluid accumulation around the heart.

A patient experienced a severe compression to the chest when trapped between a vehicle and a brick wall. You suspect traumatic asphyxia due to the hemorrhage into the sclera of his eyes and which other sign?

• Flat neck veins

• Cyanosis in the face and neck

• Asymmetrical chest movement

• Irregular heart rate

Answer explanation

Cyanosis in the face and neck is a key sign of traumatic asphyxia, indicating inadequate oxygenation due to chest compression. This aligns with the hemorrhage in the sclera, confirming the diagnosis.

A 14-year-old baseball player was hit in the chest with a line drive. He is in cardiac arrest. Which of the following is the most likely explanation?

• Commotio cordis

• Traumatic asphyxia

• Myocardial contusion

• Hemothorax

Answer explanation

Commotio cordis occurs when a blunt impact to the chest disrupts the heart's rhythm, leading to cardiac arrest. This is the most likely explanation for the 14-year-old baseball player being in cardiac arrest after being hit.

Paradoxical chest movement is typically seen in patients with:

• a pneumothorax.

• a flail chest.

• isolated rib fractures.

• a ruptured diaphragm.

Answer explanation

Paradoxical chest movement occurs when a segment of the chest wall moves in the opposite direction during breathing. This is typically seen in a flail chest, where multiple adjacent ribs are fractured, causing this abnormal movement.

A 40-year-old man, who was the unrestrained driver of a car that hit a tree at a high rate of speed, struck the steering wheel with his chest. He has a large bruise over the sternum and an irregular pulse rate of 120 beats/min. You should be MOST concerned that he:

• has injured his myocardium.

• has a collapsed lung and severe hypoxia.

• has extensive bleeding into the pericardial sac.

• is at extremely high risk for ventricular fibrillation.

Answer explanation

The mechanism of injury suggests potential blunt trauma to the chest, which can lead to myocardial contusion. The irregular pulse rate indicates possible cardiac involvement, making myocardial injury the most concerning issue.