Deck 22: Flail Chest

Question 1

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 1

Air is shunted from one lung to the other.

Question 2

What is the most common finding at the site of the flail portion of a flail chest?

A) Pulmonary contusion
B) Pulmonary abscess
C) Pulmonary edema
D) Pulmonary fibrosis

Answer 2

Pulmonary contusion

Question 3

All of the following are causes of a flail chest EXCEPT:

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

Answer 3

split sternum for open heart surgery.

Question 4

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) 1, 2, 3, 4

Question 5

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, 2, 3, 4

Question 6

Which of the following accurately describes a flail chest?

A) Double fractures of 2 adjacent ribs
B) Double fractures of 3 adjacent ribs
C) Single fracture of 3 adjacent ribs
D) Triple fractures of 2 adjacent ribs

Question 7

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

Question 8

What is the term for abnormal gas movement from one lung to the other?

A) Paradoxical movement
B) Pendelluft
C) Palindromic breathing
D) Pneumatic shift

Question 9

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, 2, 3, 4

Question 10

Which of the following statements is TRUE regarding paradoxical chest movement?

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

Question 11

How many days of ventilatory support are anticipated for a patient with a flail chest to allow sufficient time for bone healing?

A) 3 to 5 days
B) 5 to 10 days
C) 12 to 15 days
D) 18 to 21 days

Question 12

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

Question 13

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

Question 14

What is the primary cause of hypoxemia in a patient with a severe flail chest?

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

Question 15

Which breath sounds would be expected to be heard when auscultating the chest of a patient with a flail chest?

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

Question 16

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) Pain and anxiety

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