1	Thoracic Trauma Test Review
2	Question What are the first two leading causes of death in motor vehicle accidents?
3	Answer 1st – head trauma 2nd – thoracic trauma
4	Question What should you do FIRST after discovering a “sucking chest wound”?
5	Answer Cover with a gloved hand and stop your assessment to apply a 3 sided occlusive dressing
6	Question What are the findings of a tension pneumothorax?
7	Answer Absent (or extremely decreased breath sounds on affected side Positive JVD Tracheal shift to good lung (late) Hyperresonance to percussion
8	Question True or False Hypothermia is possible from any patient in a shock state, and these patients should be covered with a blanket to prevent heat loss.
9	Answer True
10	Question True or False Failure to adequately assess lung sounds would most negatively impact a differential diagnosis between a pneumothorax and a hemothorax.
11	Answer False These are very difficult to distinguish in the prehospital setting anyway. Not assessing lung sounds would more likely affect the differential diagnosis of a tension pneumothorax and a pericardial tamponade.
12	Question Of the common 14 thoracic trauma injuries discussed in class, which one has the most obscure signs and symptoms and is most commonly diagnosed based on the MOI of the accident?
13	Answer Myocardial contusion
14	Question When should a tension pneumothorax be decompressed?
15	Answer On scene as soon as it is discovered. You should consider stopping your trauma assessment to manage this injury!
16	Question What would be the greatest negative result of misdiagnosing an injury as a pericardial tamponade and not a tension pneumothorax?
17	Answer Delay in decompressing the chest
18	Question What is the cause of hypotension in a patient with a tension pneumothorax?
19	Answer Increased intrathoracic pressure decreases the blood return to the heart.
20	Question What is the best method to distinguish a pneumothorax verses a hemothorax?
21	Answer Chest percussion
22	Question What causes patechiae in cases caused by traumatic asphyxia?
23	Answer The backflow of blood damaging microcirculation
24	Question True or False The treatment priority for a tracheobronchial tear is positive pressure ventilations via an endotracheal tube.
25	Answer False PPV and ETT should be avoided and airway maintenance with suctioning should become a priority to avoid subcutaneous emphysema
26	Question What is the most common location for disruptions in anatomy secondary to a tracheobronchial injury?
27	Answer Near the Carina
28	Question What is the greatest life threat from a traumatic esophageal rupture?
29	Answer Peritonitis damaging mediastinal organs
30	Question What causes the increase in blood pressure secondary to dissecting aortic aneurysms?
31	Answer Sympathetic nerve fibers response to stretching of the aorta
32	Question What diagnosis can be made form a patient suffering blunt force trauma to the chest with decreased breath sounds, no JVD, lung lobe rales or crackles, decreased SpO2, tachypnea and tachycardia?
33	Answer Pulmonary contusion
34	Question What are the common signs and symptoms of a diaphragmatic rupture?
35	Answer Hollow appearing abdomen Bowel sounds in the chest Decreased breath sounds S/S similar to a tension pneumothorax
36	Question What is Kussmaul’s sign? (NOT Kussmaul’s respirations!)
37	Answer Decrease in JVD with inspiration with a patient suffering from a pericardial tamponade.
38	Question How much fluid is needed to fill the pericardium before s/s of a pericardial tamponade develop?
39	Answer 200 – 300mL
40	Question Which of the pulmonary injuries is typically the slowest to develop?
41	Answer Pulmonary contusion
42	Question Of the skeletal related thoracic injuries, which one most likely will require positive pressure ventilations?
43	Answer Flail Segment
44	Questions Which ribs are most commonly fractured?
45	Answer Ribs 4 – 9 along the posterior axillary line
46	Question What is the best treatment for a flail segment?
47	Answer Positive pressure ventilations
48	Question What are the most common s/s with a hemothorax?
49	Answer Diminished breath sounds Absent JVD Hyporesonance or dull percussion s/s of hypovolemic shock
50	Question What chest injury is the most common and the least severe?
51	Answer Chest wall contusion
52	Question At what landmarks should a needle chest decompression be performed?
53	Answer 2^nd or 3^rd intercostal space, superior to the rib in the midclavicular line.
54	Question What is the tidal volume for the average adult single breath?
55	Answer 500mL
56	Question What are the three divisions of the sternum from superior to inferior?
57	Answer Manubrium, Body, and Xiphoid process
58	Question What is the most critical intervention for a patient suffering from a pericardial tamponade?
59	Answer Pericardiocentesis
60	Question True or False PPV is contraindicated in traumatic esophageal injury.
61	Answer False Although it should be used with caution because of the risk of subcutaneous emphysema, PPV nor ETT is contraindicated if needed. Blind intubation devices such as a Combitube are completely contraindicated.
62	Question What are the common s/s of traumatic tracheal tearing?
63	Answer Dyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema