Question 1

Which of the following would be recommended for the management of an adult with a severe flail chest?
1) Continuous positive airway pressure (CPAP)
2) Pain management
3) Mechanical ventilation
4) Positive end-expiratory pressure (PEEP)

A)1, 2
B)2, 3
C)2, 3, 4
D)1, 3, 4

2, 3, 4

Accepted Answer

Flail chest, a serious condition resulting from multiple rib fractures, can severely impair breathing. Pain management is crucial for patient comfort and to facilitate breathing. Mechanical ventilation may be necessary to support breathing, and PEEP can help improve oxygenation and stabilize the chest wall.

Question 2

Which of the following are causes of a flail chest?
1) Blast injury
2) Motor vehicle accident
3) Split sternum for open heart surgery
4) Fall from heights

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

1, 2, 4

Accepted Answer

Flail chest can occur due to blunt trauma, often from causes such as blast injuries, motor vehicle accidents, and falls from heights, which can result in multiple rib fractures leading to a segment of the chest wall that is not structurally supported.

Question 3

Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest? A) Elevated pH and elevated SaO₂ B) Decreased pH and decreased SaO₂ C) Increased pH and decreased SaO₂ D) Decreased pH and increased SaO₂

Accepted Answer

A flail chest is a condition in which a portion of the chest wall is detached from the rest of the chest wall. This can lead to paradoxical movement of the chest wall, which can impair ventilation and oxygenation. In a patient with a mild flail chest, the respiratory therapist would expect to find a decreased pH and decreased SaO2. This is because the paradoxical movement of the chest wall can lead to hypoventilation, which can cause a decrease in pH and SaO2.

Question 4

What is the most common finding at the site of the flail portion of a flail chest?&#10;A) Pulmonary contusion&#10;B) Pulmonary abscess&#10;C) Pulmonary edema&#10;D) Pulmonary fibrosis

Accepted Answer

Pulmonary contusion is the most common finding at the site of the flail portion of a flail chest, often resulting from the trauma that causes the chest wall injury.

Question 5

When a patient has a flail chest, what happens during the ventilatory cycle?&#10;A) The I:E ratio becomes inverse.&#10;B) Air leaks out through the flail area.&#10;C) Air leaks in through the flail area.&#10;D) Air is shunted from one lung to the other.

Accepted Answer

During a flail chest, the affected segment of the rib cage moves paradoxically, causing air to be shunted from one lung to the other during the ventilatory cycle.

Question 6

Which of the following chest radiograph findings would be expected for a patient with a flail chest?
1) Increased opacity
2) Rib fractures
3) Decreased opacity
4) Tracheal deviation

A)1, 2
B)1, 4
C)2, 3
D)2, 4

Accepted Answer

Flail chest is characterized by multiple rib fractures, which can lead to paradoxical chest wall movement and potentially areas of decreased lung opacity due to lung contusion or atelectasis. Tracheal deviation is more commonly associated with tension pneumothorax or large pleural effusions.

Question 7

Which of the following statements is true regarding paradoxical chest movement?&#10;A) With inspiration, the flail section moves outward.&#10;B) The trachea deviates away from the flail side of the chest.&#10;C) During inspiration, the flail section moves inward.&#10;D) During exhalation, the flail area moves inward.

Accepted Answer

Paradoxical chest movement occurs when a section of the chest wall moves inward during inspiration and outward during expiration, opposite to the normal movement. This is due to the instability of the chest wall from multiple rib fractures, known as a flail chest.

Question 8

Which of the following accurately describes a flail chest?&#10;A) Double fractures of two adjacent ribs&#10;B) Double fractures of three adjacent ribs&#10;C) Single fracture of three adjacent ribs&#10;D) Triple fractures of two adjacent ribs

Accepted Answer

Flail chest occurs when there is a double fracture of three or more adjacent ribs, causing a segment of the chest wall to become detached from the rest of the thoracic cage and move independently. This condition is serious and can lead to respiratory compromise.

Question 9

While assessing a patient who was involved in a serious car crash and hit his steering wheel, the respiratory therapist observes that a section of his left anterior chest wall sinks inward during inspiration. What is the most likely cause?

A) Pulmonary fibrosis
B) Flail chest
C) Pneumothorax
D) Cardiac tamponade

Accepted Answer

The observed symptom of a section of the chest wall sinking inward during inspiration, known as paradoxical chest movement, is characteristic of flail chest. This condition typically results from trauma that causes multiple adjacent ribs to fracture in multiple places, leading to instability in the chest wall.

Question 10

A patient with a flail chest is experiencing pendelluft. Which of the following would be expected in a patient with a flail chest with pendelluft?
1) Hypoventilation
2) Hypertension
3) Cyclical deeper and then more shallow breathing
4) Rebreathing dead-space gas

A)1, 4
B)1, 3
C)2, 3, 4
D)1, 3, 4

Accepted Answer

Pendelluft in flail chest leads to hypoventilation due to the paradoxical movement of the chest wall, impairing effective ventilation. This results in rebreathing of dead-space gas, as air moves between areas of the lung with different ventilation capacities instead of being exchanged with the external environment.

Question 11

Which breath sounds would be expected to be heard when auscultating the chest of a patient with a flail chest?&#10;A) Diminished over the flail chest section only&#10;B) Diminished over both lungs&#10;C) Crackles over the flail chest section&#10;D) Bilateral wheezing

Accepted Answer

The answer of Which breath sounds would be expected to...

Question 12

What is the term for abnormal gas movement from one lung to the other?&#10;A) Paradoxical movement&#10;B) Pendelluft&#10;C) Palindromic breathing&#10;D) Pneumatic shift

Accepted Answer

The answer of What is the term for abnormal gas...

Question 13

What is the primary cause of hypoxemia in a patient with a severe flail chest?&#10;A) Myocardial contusion&#10;B) Hemorrhage&#10;C) Pulmonary edema&#10;D) Alveolar atelectasis

Accepted Answer

The answer of What is the primary cause of hypoxemia...

Question 14

Which of the following can stimulate an increased respiratory rate when a flail chest is present?
1) Activation of deflation receptors
2) Activation of irritant receptors
3) Stimulation of J receptors
4) Hypotension

A)1, 3
B)1, 4
C)1, 2, 3
D)2, 3, 4

Accepted Answer

The answer of Which of the following can stimulate an...

Question 15

How many days of ventilatory support are anticipated for a patient with a flail chest to allow sufficient time for bone healing?&#10;A) 3 to 5 days&#10;B) 5 to 10 days&#10;C) 12 to 15 days&#10;D) 18 to 21 days

Accepted Answer

The answer of How many days of ventilatory support are...

Question 16

Which of the following are pathologic changes associated with a flail chest?
1) Pneumothorax
2) Secondary pneumonia
3) Pleural effusion
4) Elevated diaphragms

A)1, 2
B)3, 4
C)1, 3, 4
D)2, 3, 4

Accepted Answer

The answer of Which of the following are pathologic changes...

Deck 22: Flail Chest