Assessment and Management Priorities: eFAST, Positive-pressure Ventilation, Traumatic Arrest, and Special Populations Practice Questions

25 multiple-choice questions on Assessment and management priorities: eFAST, positive-pressure ventilation, traumatic arrest, and special populations for paramedic and EMT students, from Chapter 36 (Chest Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. During the primary survey of a 30-year-old after a high-speed crash, which chest injury must be found and treated immediately?

   1. A. Tension pneumothorax
   2. B. Isolated rib fracture
   3. C. Esophageal contusion
   4. D. Small simple hemothorax
   Show answer

   Answer: A. Tension pneumothorax

   Tension pneumothorax kills within minutes and is treated as soon as it is found, along with open pneumothorax, massive hemothorax, flail chest, and tamponade. An isolated rib fracture is identified in the secondary assessment.

2. Chest injuries account for about what share of trauma deaths?

   1. A. About 25%
   2. B. About 5%
   3. C. About 60%
   4. D. About 90%
   Show answer

   Answer: A. About 25%

   Thoracic trauma causes roughly one in four trauma deaths, and many of those deaths are preventable with early recognition. Most chest injuries can be managed without surgery, so recognizing the few lethal ones matters most.

3. During the primary survey of a patient with chest trauma, the chest should be:

   1. A. Auscultated through the clothing to save scene time
   2. B. Fully exposed, inspected, palpated, and auscultated
   3. C. Examined if the patient reports chest pain
   4. D. Palpated after transport at the hospital
   Show answer

   Answer: B. Fully exposed, inspected, palpated, and auscultated

   Wounds, bruising, asymmetry, and paradoxical motion are missed unless the chest is exposed and examined. A patient with a distracting injury or altered mental status may not report chest pain at all.

4. The extended FAST (eFAST) examination adds evaluation of the:

   1. A. Long bones for hidden fractures in the legs
   2. B. Aorta for a dissection flap in the chest
   3. C. Pleural spaces for pneumothorax and blood
   4. D. Kidneys for urinary obstruction or stones
   Show answer

   Answer: C. Pleural spaces for pneumothorax and blood

   eFAST adds views of both hemithoraces to the standard abdominal and pericardial views, looking for pneumothorax and hemothorax. It is not designed to diagnose aortic dissection or fractures.

5. On ultrasound, absent lung sliding at the anterior chest suggests:

   1. A. Hemothorax
   2. B. Pericardial effusion
   3. C. Normal lung
   4. D. Pneumothorax
   Show answer

   Answer: D. Pneumothorax

   Normally the visceral pleura can be seen sliding against the parietal pleura with each breath; air between them hides that movement. A hemothorax shows up as a dark fluid collection in the dependent chest instead.

6. Where prehospital eFAST is used, it should be:

   1. A. Completed before leaving the scene
   2. B. Done en route without delaying transport
   3. C. Used in place of serial physical exams
   4. D. Relied on to rule out injury whenever it is negative
   Show answer

   Answer: B. Done en route without delaying transport

   A negative scan does not exclude significant injury, and a positive scan does not change the need for rapid transport. Doing it on scene adds time the patient may not have.

7. A patient with a known small pneumothorax is intubated and ventilated. He is now at greatest risk of:

   1. A. Spontaneous resolution of the pneumothorax
   2. B. Developing traumatic asphyxia
   3. C. Progression to tension pneumothorax
   4. D. Developing a flail chest segment
   Show answer

   Answer: C. Progression to tension pneumothorax

   Positive pressure forces air through the lung injury into the pleural space with every breath, so tension can develop quickly. Ventilation does not make a pneumothorax resolve, and reassessment after intubation is essential.

8. In a hypovolemic chest trauma patient, aggressive bag-valve ventilation can lower the BP because it:

   1. A. Raises intrathoracic pressure and cuts venous return
   2. B. Increases preload and overstretches the heart
   3. C. Raises the oxygen level and dilates the vessels
   4. D. Pushes air into the pericardial sac with each breath given
   Show answer

   Answer: A. Raises intrathoracic pressure and cuts venous return

   Positive pressure squeezes the vena cavae and reduces filling, which a volume-depleted heart cannot tolerate. It lowers preload, so overstretching the heart is the opposite of what happens.

9. A patient with a sucking chest wound has been intubated and is receiving positive-pressure ventilation. Regarding the open wound, you should know that:

   1. A. A nonvented seal is now preferred
   2. B. Air can no longer leave through the wound
   3. C. Tension pneumothorax becomes less likely
   4. D. PPV inflates the lungs despite the wound
   Show answer

   Answer: D. PPV inflates the lungs despite the wound

   With positive-pressure ventilation, air is pushed into the lungs through the tube, so an open chest wound no longer prevents lung inflation the way it does with spontaneous breathing. Air can still leak out through the wound. The wound should still be covered with a vented seal rather than a nonvented one, and the patient monitored for tension pneumothorax, which PPV makes more likely, not less.

10. Right after positive-pressure ventilation is started for a patient with a penetrating lung injury, he has a seizure and new right-sided weakness. Breath sounds are equal. The most likely cause is:

    1. A. Tension pneumothorax
    2. B. Systemic air embolism
    3. C. Cardiac tamponade
    4. D. Hypoglycemic seizure
    Show answer

    Answer: B. Systemic air embolism

    Positive pressure can force air from injured airways into pulmonary veins, which carry it to the brain and coronary arteries. Tension pneumothorax causes shock and unilateral loss of breath sounds, not focal neurologic signs.

11. The HOTT mnemonic for reversible causes of traumatic cardiac arrest stands for:

    1. A. Hypothermia, opioid overdose, thrombosis, and toxins
    2. B. Hypoglycemia, overdose, tachycardia, and temperature
    3. C. Hemorrhage, obstruction, tracheal shift, and trauma
    4. D. Hypovolemia, oxygenation, tension pneumothorax, tamponade
    Show answer

    Answer: D. Hypovolemia, oxygenation, tension pneumothorax, tamponade

    HOTT focuses traumatic arrest care on volume, the airway and oxygenation, tension pneumothorax, and tamponade. The other lists resemble the H's and T's of medical arrest, which are less often the cause in trauma.

12. A 28-year-old in a rollover crash is in cardiac arrest with blunt chest trauma. The airway is secured, and external bleeding is controlled. The monitor shows PEA. Your next intervention is:

    1. A. Bilateral needle decompression
    2. B. Epinephrine 1 mg every 3 to 5 min
    3. C. Amiodarone 300 mg rapid IV push
    4. D. Synchronized cardioversion at 100 J
    Show answer

    Answer: A. Bilateral needle decompression

    In blunt chest trauma, tension pneumothorax is a common reversible cause of traumatic arrest, and decompressing both sides treats it without having to localize it. Current NAEMSP/ACS-COT/ACEP guidance supports decompression when chest trauma is suspected, as here, but not empiric bilateral decompression without it. Epinephrine has a lower priority than correcting the mechanical and volume causes and should not precede them. Amiodarone is for shockable rhythms, not PEA. Synchronized cardioversion needs an organized rhythm with a pulse; it has no role in pulseless PEA.

13. In traumatic cardiac arrest from blood loss, epinephrine is:

    1. A. The first drug, given ahead of other steps
    2. B. Given at double the standard dose
    3. C. Secondary to volume and decompression
    4. D. Given before the airway is managed
    Show answer

    Answer: C. Secondary to volume and decompression

    A heart with no volume or with an obstructed outflow will not respond to vasopressors, so hemorrhage control, volume replacement, oxygenation, and decompression of a tension pneumothorax come first; the 2025 NAEMSP/ACS-COT/ACEP statement says epinephrine should not be routine and should not precede these. Giving it first follows the medical arrest sequence and delays the treatments that work. There is no higher dose for trauma. Airway management is one of the reversible-cause interventions, so epinephrine does not come before it.

14. Chest compressions in traumatic arrest from hemorrhage are less effective than in medical arrest because:

    1. A. The ribs are already fractured
    2. B. Compressions cause tension pneumothorax
    3. C. The heart is usually in ventricular fibrillation
    4. D. There is too little blood to circulate
    Show answer

    Answer: D. There is too little blood to circulate

    Compressions move blood only if there is blood in the heart to move, so volume replacement is essential. Most traumatic arrests present in PEA or asystole, not VF.

15. Under current NAEMSP/ACS-COT/ACEP guidance, resuscitation should be withheld from a pulseless trauma patient who has:

    1. A. Penetrating trauma with PEA at a rate of 80
    2. B. Rigor mortis and dependent lividity present
    3. C. Cardiac arrest after a fall of over 20 feet
    4. D. Blunt trauma with VF on the cardiac monitor
    Show answer

    Answer: B. Rigor mortis and dependent lividity present

    Rigor mortis and dependent lividity show a prolonged arrest, and with injuries clearly incompatible with life (such as decapitation) or a valid DNR order they are the current reasons to withhold resuscitation in traumatic arrest. Penetrating trauma with organized electrical activity may be reversible with rapid transport and surgery. Mechanism alone, such as a fall of over 20 feet, should not decide whether to resuscitate. VF is a shockable rhythm and is treated. Many local protocols still also withhold for blunt trauma with asystole under the older 2013 criteria, but the 2025 statement says rhythm should not be the sole determinant. (NAEMSP/ACS-COT/ACEP 2025 joint statement; NAEMSP/ACS-COT 2013.)

16. A 19-year-old stabbed in the chest loses his pulse while you are 4 minutes from a trauma center. The best plan is to:

    1. A. Work the arrest on scene for 20 minutes first
    2. B. Terminate resuscitation on scene now
    3. C. Treat reversible causes and transport at once
    4. D. Give epinephrine and wait for ROSC
    Show answer

    Answer: C. Treat reversible causes and transport at once

    Penetrating chest trauma with a short transport time is the situation in which emergency thoracotomy at the hospital can save a life. Staying on scene wastes the brief window for surgical repair.

17. A 6-year-old struck by a car has a bruised chest but no rib crepitus. His respiratory rate is 40 breaths/min, and his SpO2 is 90%. You should:

    1. A. Suspect underlying lung injury despite no fractures
    2. B. Assume a minor bruise, since the ribs are intact
    3. C. Suspect asthma, since children rarely have contusions
    4. D. Treat for anxiety, since the vitals are normal for age
    Show answer

    Answer: A. Suspect underlying lung injury despite no fractures

    A child's flexible ribs transmit force to the lungs and heart without breaking, so serious internal injury can occur with intact ribs. A rate of 40 and an SpO2 of 90% are abnormal for a 6-year-old.

18. Rib fractures in a young child are significant because they:

    1. A. Are common after minor falls during play
    2. B. Indicate that a large force was applied
    3. C. Heal too slowly to be splinted properly
    4. D. Signal bone disease more often than injury
    Show answer

    Answer: B. Indicate that a large force was applied

    Pediatric ribs bend rather than break, so a fracture means substantial force and raises the risk of internal injury; unexplained fractures should also raise concern for abuse. Rib fractures are not a common result of minor play.

19. An 82-year-old who fell at home has three rib fractures. His SpO2 is 93%, and his respiratory rate is 24 breaths/min. He wants to stay home. You should advise:

    1. A. Staying home, since three fractures heal well at home
    2. B. Binding the chest and following up with his doctor
    3. C. Rest and ice at home, with transport if he worsens
    4. D. Transport, since rib fractures are high risk at his age
    Show answer

    Answer: D. Transport, since rib fractures are high risk at his age

    In older adults, each additional rib fracture increases the risk of pneumonia, respiratory failure, and death. Binding the chest worsens hypoventilation, and waiting for him to worsen at home delays care.

20. A 75-year-old taking apixaban has rib fractures after a fall. Compared with a patient not on anticoagulants, she is at higher risk of:

    1. A. Commotio cordis
    2. B. Traumatic asphyxia
    3. C. Delayed hemothorax
    4. D. Spontaneous pneumothorax
    Show answer

    Answer: C. Delayed hemothorax

    Anticoagulants let small rib-fracture bleeds continue, so blood can collect slowly in the pleural space. Spontaneous pneumothorax is a nontraumatic condition and is not linked to anticoagulants.

21. A woman who is 36 weeks pregnant has a tension pneumothorax, and you plan to use the lateral decompression site. Compared with a nonpregnant adult, you should:

    1. A. Go 1 or 2 interspaces higher than usual
    2. B. Go to the 6th or 7th space to clear the breast
    3. C. Delay decompression until the fetus is assessed
    4. D. Use the 2nd space at the sternal border instead
    Show answer

    Answer: A. Go 1 or 2 interspaces higher than usual

    Late in pregnancy the uterus pushes the diaphragm up by about 4 cm, so a needle or tube placed at the usual lateral site, or below it, is more likely to enter the abdomen; ATLS advises placing a chest tube one or two interspaces higher than usual in pregnancy, and the same logic applies to the lateral needle site. Going to the 6th or 7th space makes that risk worse. Decompression is not delayed for fetal assessment, because resuscitating the mother is the best treatment for the fetus. The sternal border risks the internal mammary vessels and the heart and is not an approved site. (ATLS 10th ed., Ch. 12; PHTLS 10th ed.)

22. Pregnant trauma patients desaturate quickly during apnea mainly because:

    1. A. Oxygen use falls in late pregnancy
    2. B. Progesterone slows the breathing rate in pregnancy
    3. C. The raised diaphragm reduces oxygen reserve
    4. D. Blood volume falls during pregnancy
    Show answer

    Answer: C. The raised diaphragm reduces oxygen reserve

    The enlarged uterus pushes the diaphragm up and reduces functional residual capacity, while oxygen demand rises. Progesterone stimulates rather than slows ventilation, oxygen consumption rises rather than falls, and blood volume actually increases by up to about 50% in pregnancy.

23. A 30-year-old with chest trauma is in shock, and you are about to leave the scene. Which intervention should be done before you leave rather than en route?

    1. A. Starting two large-bore IV lines
    2. B. A complete head-to-toe secondary exam
    3. C. Splinting a closed forearm fracture
    4. D. Decompressing a tension pneumothorax
    Show answer

    Answer: D. Decompressing a tension pneumothorax

    For a critical trauma patient, the goal is a scene time of about 10 minutes, so only interventions that keep the patient alive long enough to reach surgery (airway, hemorrhage control, sealing an open chest wound, decompressing a tension pneumothorax) are done before leaving. Vascular access can be gained during transport without delaying definitive care. The detailed secondary exam is done en route, or not at all if the primary survey problems take all your time. A closed forearm fracture is not life-threatening and can be splinted to the board or during transport. (PHTLS 10th ed.; ATLS 10th ed.)

24. In a ventilated trauma patient with a stable ventilation rate and an intact waveform, a sudden fall in ETCO2 most often reflects:

    1. A. Improving ventilation and perfusion
    2. B. Falling cardiac output and perfusion
    3. C. Rising metabolic rate from a fever
    4. D. Hypoventilation with CO2 retention
    Show answer

    Answer: B. Falling cardiac output and perfusion

    If ventilation is unchanged, ETCO2 depends on blood flow carrying CO2 to the lungs, so a sudden drop warns of tension, tamponade, or hemorrhage. Hypoventilation raises ETCO2 rather than lowering it.

25. A patient has an isolated stab wound to the chest with no neurologic complaints or deficits. Spinal motion restriction is:

    1. A. Not routinely needed and may delay care
    2. B. Needed with a collar and long backboard
    3. C. Needed for every penetrating chest wound
    4. D. Needed when the wound bleeds heavily
    Show answer

    Answer: A. Not routinely needed and may delay care

    Penetrating trauma without neurologic signs rarely causes an unstable spine, and immobilization delays transport and can impair breathing. Bleeding from the wound does not indicate a spinal injury.