PHTLS Thoracic Trauma 2

Question 1

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?

Accepted Answer

Tension pneumothorax

Answer

Massive hemothorax

Answer

Open pneumothorax

Answer

Cardiac tamponade

Question 2

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?

Accepted Answer

3 or more ribs in 2 places

Answer

2 ribs in 1 place

Answer

1 rib in 2 places

Answer

4 or more ribs in 1 place

Question 3

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

Accepted Answer

The flail segment moves inward on inspiration and outward on expiration

Answer

The flail segment moves outward on inspiration and inward on expiration

Answer

The flail segment remains stationary due to muscle splinting

Answer

The flail segment collapses only during forced expiration

Question 4

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?

Accepted Answer

Rib fractures with potential hemothorax or pneumothorax

Answer

Pulmonary contusion

Answer

Esophageal rupture

Answer

Diaphragmatic tear

Question 5

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?

Accepted Answer

Remove the seal to release potential tension buildup

Answer

Apply a second vented seal over the first

Answer

Increase oxygen flow rate

Answer

Perform needle decompression on the opposite side

Question 6

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

Accepted Answer

Hypotension, tachycardia, absent breath sounds, flat neck veins

Answer

Hypertension, bradycardia, JVD

Answer

Hypotension, bradycardia, JVD, muffled heart sounds

Answer

Hypertension, tachycardia, tracheal deviation

Question 7

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

Accepted Answer

Aortic isthmus just distal to the left subclavian artery

Answer

Ascending aorta at the aortic valve

Answer

Descending thoracic aorta at the diaphragm

Answer

Aortic arch between the brachiocephalic vessels