11) An individual is struck in the left ventricle with a high-velocity projectile. As compared to low-velocity penetrating trauma, you should have a higher index of suspicion for: A) Ventricular rupture B) Pericardial tamponade C) Simple penetrating injury D) Blunt cardiac injury 12) Your patient received a blow to the left lateral chest at the level of the sixth and seventh ribs. You should suspect fractures at: A) The point of impact of the sixth rib only B) The point of impact and the posterior axillary line of the sixth rib only C) The point of impact on both ribs D) The point of impact and the posterior axillary line of both ribs 13) You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old female with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient’s EMT partner has applied oxygen by nonrebreathing mask and an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient’s level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is nonguarded and nontender. Which of the following best explains the presentation of this patient? A) Simple pneumothorax B) Tension pneumothorax C) Pericardial tamponade D) Hemothorax 14) You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old female with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient’s EMT partner has applied oxygen by nonrebreathing mask and an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient’s level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and the abdomen is nonguarded and nontender. Which of the following should you do first? A) Start a large-bore IV of isotonic crystalloid solution B) Do a rapid trauma assessment C) Assist ventilations with a bag-valve-mask device D) Do an immediate needle chest decompression 15) Which of the following is TRUE of pulmonary contusion? A) Signs and symptoms generally develop gradually. B) Pulmonary contusion is typically an isolated injury. C) The primary pathophysiology is that the alveoli are filled with blood. D) Pulmonary contusion results in paradoxical motion of the chest wall. 16) Which of the following is the primary prehospital concern with a simple, isolated fracture of the fifth rib in the right posterior-axillary line? A) Hemorrhage B) Pneumonia C) Hypoventilation D) Liver contusion 17) Which of the following best describes the threat to life associated with traumatic rupture of the esophagus? A) Entry of gastric contents into the mediastinum B) Hypoxia C) Decreased cardiac output D) Massive hemorrhage 18) Which of the following best describes the epidemiology of sternal fracture? A) Low incidence, low mortality B) High incidence, high mortality C) High incidence, low mortality D) Low incidence, high mortality 19) Abdominal trauma should be suspected with penetrating thoracic wounds below the ________ rib anteriorly and the ________ rib posteriorly. A) Fourth, ninth B) Second, fifth C) Fourth, sixth D) Second, tenth 20) Your patient is an 80-year-old male who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is MOST needed in this patient? A) Infusion of isotonic crystalloid solution using a large-bore IV B) Application of bulky dressings over the site of paradoxical motion C) Being placed in a prone position to stabilize the chest wall D) Intubation and positive-pressure ventilation