Thoracic Trauma Flashcards

A patient with blunt chest trauma presents with absent breath sounds on the right, tracheal deviation to the left, and JVD. Which condition does this most likely represent?

Answer: Tension pneumothorax

Tension pneumothorax classically presents with absent breath sounds, tracheal deviation away from the affected side, and JVD due to mediastinal shift.

During assessment of a chest trauma patient, you note paradoxical chest wall movement over a section of ribs. What minimum number of consecutive rib fractures in two places typically produces this finding?

Answer: 3 or more ribs in 2 places

A flail segment requires three or more adjacent ribs fractured in at least two places, creating a free-floating segment that moves paradoxically.

Which of the following best describes the pathophysiology of paradoxical motion seen in flail chest?

Answer: The flail segment moves inward on inspiration and outward on expiration

The flail segment moves paradoxically — inward during inspiration (when pleural pressure drops) and outward during expiration.

A construction worker falls from scaffolding and complains of severe chest pain. Palpation reveals crepitus along the left lateral chest wall. Which immediate life threat should be highest on your differential?

Answer: Rib fractures with potential hemothorax or pneumothorax

Crepitus over the chest wall indicates rib fractures, which carry significant risk of associated hemothorax or pneumothorax requiring rapid assessment.

In prehospital management of a sucking chest wound, after applying a vented chest seal, the patient deteriorates with increasing respiratory distress and decreasing SpO2. What is the next step?

Answer: Remove the seal to release potential tension buildup

If a patient with a vented chest seal deteriorates, the seal should be lifted or removed to relieve a developing tension pneumothorax.

Which hemodynamic pattern is most consistent with massive hemothorax in a trauma patient?

Answer: Hypotension, tachycardia, absent breath sounds, flat neck veins

Massive hemothorax presents with hemorrhagic shock signs (hypotension, tachycardia) and absent breath sounds on the affected side, with flat neck veins from blood loss.

Which anatomic structure is at greatest risk of injury in a deceleration mechanism causing thoracic aortic disruption?

Answer: Aortic isthmus just distal to the left subclavian artery

The aortic isthmus, fixed by the ligamentum arteriosum just distal to the left subclavian, is the most common site of traumatic aortic disruption due to shear forces.

A trauma patient has muffled heart sounds, hypotension, and distended neck veins after a stab wound to the chest. Which intervention is indicated in the prehospital setting for suspected cardiac tamponade?

Answer: Rapid transport with IV access and fluid resuscitation en route

Prehospital management of cardiac tamponade is rapid transport with IV fluid support; pericardiocentesis is a hospital-level intervention.

A 45-year-old restrained driver involved in a high-speed MVC has chest pain and shortening of breath. ECG shows sinus tachycardia with frequent PVCs. Lung sounds are clear bilaterally. What should you suspect?

Answer: Myocardial contusion

Blunt cardiac injury (myocardial contusion) commonly presents with dysrhythmias after significant chest wall impact and should be suspected with sternal or significant anterior chest trauma.

When performing needle thoracostomy for suspected tension pneumothorax, what is the preferred anatomic landmark using the anterior approach?

Answer: 2nd intercostal space, midclavicular line, superior border of the 3rd rib

The needle is inserted at the 2nd ICS midclavicular line over the superior border of the 3rd rib to avoid the neurovascular bundle running beneath each rib.

Following needle decompression for tension pneumothorax, a rush of air is heard but the patient does not improve clinically. What is the most likely explanation?

Answer: Needle was too short to reach the pleural space

A needle that is too short may not penetrate the pleural space in patients with a thick chest wall, resulting in failure of decompression despite air sound from subcutaneous tissue.

A patient with multiple rib fractures is breathing at 28 breaths/min and is hypoxic. High-flow oxygen is applied. What additional prehospital intervention most directly addresses ventilatory failure from flail chest?

Answer: Positive pressure ventilation via BVM

Positive pressure ventilation internally splints the flail segment and supports ventilation, directly addressing the underlying mechanism of failure.

Which of the following injuries is most likely to cause immediate exsanguination and death before hospital arrival in thoracic trauma?

Answer: Traumatic aortic disruption with full transection

Complete transection of the thoracic aorta causes massive hemorrhage and is nearly universally fatal at the scene; survivors typically have a contained pseudoaneurysm.

A 30-year-old motorcyclist has a penetrating chest wound that produces a loud sucking noise with each breath. After sealing the wound, what should be monitored to detect a developing complication?

Answer: Signs of tension pneumothorax: worsening dyspnea, absent breath sounds, hypotension

After sealing an open pneumothorax, continued monitoring for tension pneumothorax is essential as the seal can trap air and convert a simple to a tension pneumothorax.

A trauma patient has no breath sounds on the left after intubation. The most immediate action is to:

Answer: Withdraw the ETT 2 cm and reassess breath sounds

Absent unilateral breath sounds after intubation most commonly indicate right mainstem intubation; withdrawing the ETT slightly and reassessing is the first corrective action.

Which of the following best explains why pulmonary contusion causes hypoxemia?

Answer: Hemorrhage into alveoli creates an intrapulmonary shunt

Blood-filled alveoli are perfused but not ventilated, creating an intrapulmonary shunt that results in hypoxemia refractory to supplemental oxygen.

In the PHTLS approach, which of the following thoracic injuries is managed primarily by rapid transport rather than scene intervention?

Answer: Cardiac tamponade

Cardiac tamponade requires pericardiocentesis or surgical drainage, which are hospital-level interventions; prehospital care focuses on rapid transport and supportive care.

A 55-year-old is ejected from a vehicle and presents with subcutaneous emphysema across the entire chest and neck. What thoracic injury should be highest on the differential?

Answer: Tracheobronchial injury

Widespread subcutaneous emphysema following blunt thoracic trauma is a hallmark of tracheobronchial disruption, allowing large volumes of air to escape into soft tissues.

Which of the following is the most reliable clinical sign distinguishing tension pneumothorax from massive hemothorax in the field?

Answer: Tracheal deviation and neck vein status

Tension pneumothorax causes JVD and tracheal deviation from increased intrathoracic pressure, while massive hemothorax produces flat neck veins due to hemorrhagic shock.

According to PHTLS principles, what is the primary indication for performing needle decompression in the prehospital environment?

Answer: Clinical suspicion of tension pneumothorax with hemodynamic instability

PHTLS indicates needle decompression when tension pneumothorax is clinically suspected with hemodynamic compromise; absent sounds alone are insufficient in the field.