PHTLS Thoracic Trauma 2 — Questions and Answers
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?
- Massive hemothorax
- Tension pneumothorax (Correct answer)
- Open pneumothorax
- Cardiac tamponade
Correct answer: Tension pneumothorax
Tension pneumothorax classically presents with absent breath sounds, tracheal deviation away from the affected side, and JVD due to mediastinal shift.
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?
- 2 ribs in 1 place
- 3 or more ribs in 2 places (Correct answer)
- 1 rib in 2 places
- 4 or more ribs in 1 place
Correct 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.
Question 3: Which of the following best describes the pathophysiology of paradoxical motion seen in flail chest?
- The flail segment moves inward on inspiration and outward on expiration (Correct answer)
- The flail segment moves outward on inspiration and inward on expiration
- The flail segment remains stationary due to muscle splinting
- The flail segment collapses only during forced expiration
Correct 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.
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?
- Pulmonary contusion
- Rib fractures with potential hemothorax or pneumothorax (Correct answer)
- Esophageal rupture
- Diaphragmatic tear
Correct 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.
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?
- Apply a second vented seal over the first
- Remove the seal to release potential tension buildup (Correct answer)
- Increase oxygen flow rate
- Perform needle decompression on the opposite side
Correct 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.
Question 6: Which hemodynamic pattern is most consistent with massive hemothorax in a trauma patient?
- Hypertension, bradycardia, JVD
- Hypotension, tachycardia, absent breath sounds, flat neck veins (Correct answer)
- Hypotension, bradycardia, JVD, muffled heart sounds
- Hypertension, tachycardia, tracheal deviation
Correct 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.
Question 7: Which anatomic structure is at greatest risk of injury in a deceleration mechanism causing thoracic aortic disruption?
- Ascending aorta at the aortic valve
- Aortic isthmus just distal to the left subclavian artery (Correct answer)
- Descending thoracic aorta at the diaphragm
- Aortic arch between the brachiocephalic vessels
Correct 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.
PHTLS Thoracic Trauma 2
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?