Deck 21: Flail Chest

Question 1

A flail chest is defined as:
1) one fractured rib or two adjacent fractured ribs.
2) three or more adjacent fractured ribs.
3) single rib fractures.
4) double rib fractures.

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

Answer 1

2, 4

Question 2

While assessing a patient who was involved in a serious car crash and hit his steering wheel, you notice that his left anterior chest wall caves in during inspiration. What could cause this?

A) Singultus
B)Flail chest segment
C)Pneumothorax
D)Cardiac tamponade

Answer 2

Flail chest segment

Question 3

When a patient has a flail chest, what happens during the ventilatory cycle?

A) The I:E ratio becomes inverse.
B)Air leaks out through the flail area.
C)Air leaks in through the flail area.
D)Air is shunted from one lung to the other.

Answer 3

Air is shunted from one lung to the other.

Question 4

Major pathologic and structural changes associated with a flail chest include:
1) pneumothorax.
2) secondary pneumonia.
3) pleural effusion.
4) elevated diaphragms.

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

Question 5

The major anatomic alterations of the lungs associated with flail chest include:
1) hemothorax.
2) diaphragm rupture.
3) atelectasis.
4) consolidation.

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

Question 6

Causes of a flail chest include all of the following EXCEPT:

A) blast injury.
B)motor vehicle accident.
C)split sternum for open heart surgery.
D)fall from high altitude.

Question 7

What is a possible lung finding under the fractured ribs of a flail chest?

A) Contusion
B)Abscess
C)Bronchospasm
D)Fibrosis

Question 8

Your patient with a flail chest is experiencing pendelluft. What are its effects?
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, 2, 3, 4

Question 9

If mechanical ventilation is required, how long will it be needed to allow sufficient time for bone healing?

A) up to 5 days
B)5 to 10 days
C)10 to15 days
D)greater than 15 days for full bone healing

Question 10

Your flail chest patient requires supplemental oxygen. What is the usual cause of hypoxemia in a flail chest patient?

A) Myocardial contusion
B)Hemorrhage
C)Pulmonary edema
D)Alveolar atelectasis

Question 11

In severe cases of flail chest, all of the following will usually be needed:
1) Continuous positive airway pressure (CPAP)
2) Pain management
3) Mechanical ventilation
4) Positive end-expiratory pressure (PEEP)

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

Question 12

Your patient with a flail chest has paradoxical chest movement. What would be seen with this?

A) With an inspiration, the fractured ribs move outward.
B)The trachea deviates away from the flail side of the chest.
C)During inspiration, the fractured ribs move inward.
D)During exhalation, the flail area moves inward.

Question 13

While assessing your patient with flail chest, you would expect to hear what kind of breath sounds?

A) Diminished over the flail chest lung
B)Diminished over both lungs
C)Crackles over the flail chest lung
D)Bilateral wheezing

Question 14

What chest radiograph findings would be expected on a patient with a flail chest?
1) Decreased opacity
2) Rib fractures
3) Increased opacity
4) Tracheal narrowing or deviation

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

Question 15

Your patient with a flail chest has developed consolidation. What should be implemented to help manage it?

A) Hyperinflation therapy protocol
B)Antibiotics
C)Mechanical ventilation protocol
D)Oxygen therapy protocol