Deck 12: Chest Trauma

Question 1

All of the following are used in the treatment of flail chest except:

A)Stabilization of chest wall using positive pressure ventilation
B)Surgically implanted rib plates or wiring
C)Negative pressure ventilation via cuirass
D)Sedatives to reduce spontaneous ventilation

Answer 1

C

Question 2

Aspiration injury to the lung following chest injury should be suspected if

A)There is a reduced PaO₂/FIO₂ ratio
B)The patient was found unconscious at time of rescue
C)Both A and B are correct
D)None of the above

Answer 2

C

Question 3

What is the main reason that tension pneumothorax is so life-threatening?

A)Worsening in
B)Circumferential pneumatic compression of chest by subcutaneous air
C)Hemodynamic compromise
D)Tracheal and mediastinal shift

Answer 3

C

Question 4

All of the following are cardiac isoenzymes that are elevated in myocardial contusion except:

A)AST
B)LDH
C)CK
D)MAO

Question 5

What is the most common cause of blunt force chest trauma in the United States?

A)Falls from roofs and ladders
B)Automobile accidents
C)Boating accidents
D)Sky diving

Question 6

Beck's triad,which includes the three signs of cardiac tamponade,contains all of the following except:

A)Distended neck veins
B)Increased pulse pressure
C)Diminished heart tones
D)Hypotension

Question 7

All of the following are true regarding subcutaneous emphysema except:

A)More common in cigarette smokers
B)Usually only a temporary cosmetic problem,serious only because of the underlying injury it may represent
C)When present,airway injury must always be suspected
D)Frequently migrates from chest to other areas

Question 8

Which is the most common site of aortic rupture in chest trauma?

A)Descending aorta near its hiatus in the diaphragm
B)Ascending aorta just distal to its semilunar valve
C)Upper thoracic aorta,near the left subclavian artery
D)Arch of the aorta near the brachiocephalic artery

Question 9

The primary survey of a chest trauma patient should be rapid,evaluating all of the following except:

A)Vital signs,e.g.,airway,breathing,heart rate,and blood pressure
B)Life-threatening hemorrhage
C)Level of consciousness
D)Chest x-ray

Question 10

Acute lung injury or acute respiratory distress syndrome is likely to develop following blunt chest trauma if

A)The injury severity score is <25
B)There is hypotension on admission
C)Patient is 15 to 25 years of age
D)Crackles are heard on inspiration

Question 11

Open or "sucking" chest wounds can lead to respiratory failure and shock by all of the following mechanisms except:

A) mismatching
B)Subcutaneous emphysema
C)Compromised alveolar ventilation
D)Pneumothorax

Question 12

What percent of chest trauma patients have injuries to the heart?

A)60%
B)40%
C)25%
D)10%

Question 13

Which of the following is NOT a classification for types of chest trauma?

A)Primary blast injury
B)Blunt trauma
C)Thoracic outlet syndrome
D)Penetrating injury

Question 14

Open or "sucking" chest wounds

A)Act as a one-way valve allowing air to exit chest during inspiration
B)Act as a one-way valve to allow air to enter chest upon inspiration
C)Act as a one-way valve to allow air to enter chest upon exhalation
D)Act as a one-way valve to allow air to exit chest upon exhalation

Question 15

Which of the following statements is true regarding flail chest?

A)It is a common accompaniment of chest injury
B)It is,more times than not,a cosmetic rather than a serious medical or surgical problem
C)Paradoxical breathing can result from chest wall instability
D)Surgery is required in all cases once the patient becomes stable

Question 16

Which of the following factors is considered by most experts to be the most important factor in predicting the severity of a penetrating wound from a projectile?

A)Length of the missile
B)Mass (weight)of the missile
C)Velocity of the missile
D)Design of the missile

Question 17

All of the following statements are true regarding rib fractures except:

A)Less likely in adults than children because adult bones are more pliable
B)Fractures of ribs one and two are rare because they are somewhat protected by the shoulder girdle
C)Sternal fractures and/or costochondral separations are often the result of motor vehicle accidents
D)Rib fractures can lead to pneumonia

Question 18

Of these group of organisms which is most likely responsible for nosocomial infection in your chest trauma patient?

A)Bacillus
B)Neisseriae
C)Hemophilus
D)Staphylococcus

Question 19

Simple (non-tension)pneumothorax generally does not cause significant physiologic impairment until what percentage of the lung has collapsed?

A)>10%
B)>30%
C)>50%
D)>75%

Question 20

All of the following can result from blunt force injury to the larynx except:

A)Sudden airway occlusion from crushed larynx
B)Cricotracheal dislocation
C)Retropharyngeal perforation
D)Airway edema

Question 21

All of the following statements are true regarding pressure-controlled inverse-ratio ventilation except:

A)It can improve lung volume,oxygenation,and ventilation
B)It can reduce peak airway pressure
C)It can increase alveolar recruitment
D)It can reduce the chance of auto-PEEP

Question 22

Which of the following is not an adjunct in difficult airway management?

A)Laryngeal mask airway
B)Cricothyrotomy with a 12-gauge needle
C)CombiTube
D)Blakemore tube

Question 23

Your chest trauma patient arrives in the emergency department wearing a cervical collar and is being assisted via a resuscitation bag.Which of the following steps would be least appropriate?

A)Nasotracheal intubation employing a bronchoscope
B)Attempt an orotracheal intubation by hyperextending the neck
C)Set up for a cricothyrotomy
D)Place an oropharyngeal airway

Question 24

Your chest trauma patient has a PaO₂ of 55 mmHg,a PaCO₂ of 58 mmHg,and a pH of 7.19. Her respirations are 36/min and shallow.Which of the following is the most appropriate next step?

A)Mechanical ventilation using assist-control with sedation
B)NPPV using BiPAP with settings initially at 12/4,and 3 L/min O₂ bleed in
C)CPAP with an FIO₂ of 0.40
D)High-flow non-rebreathing mask

Question 25

Your adult patient who is recovering from chest trauma that occurred 10 days ago is now in the spontaneous (CPAP)mode with a pressure support of 5 cwp,FIO₂ of 0.30,and a PEEP of 5 cwp.Respiratory rate is 18/min and unlabored; tidal volumes average 400-450 mL.Chest x-ray is serially improving and sensorium is appropriate.SpO₂ is 93%.What should you recommend?

A)Increase pressure support to 10 cwp
B)Extubation to an aerosol mask at 40%
C)Increase FIO₂ to 0.40
D)Both B and C are acceptable

Question 26

The secondary survey of a chest trauma victim should include all of the following except:

A)Looking for signs of tension pneumothorax
B)EEG
C)CT scan
D)CBC

Question 27

A properly sized,cuffed oral endotracheal tube helps to do all of the following except:

A)Relieve gastric insufflation
B)Protect airway and lungs from macro-aspiration
C)Facilitate mechanical ventilation
D)Relieve upper airway obstruction

Question 28

Unilateral trauma to the lung or bronchi might necessitate which of these?

A)Double-sided chest tubes
B)Placing the patient in the lateral position with the involved side down
C)Independent lung ventilation with a double-lumen endotracheal tube
D)None of the above