Question 1

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

Accepted Answer

Because of the instability of the flail area, the ribs and lung tissue will move in the opposite direction than normal during a breath. This can cause air to be shunted from one lung to the other during the ventilatory cycle.

Question 2

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

Accepted Answer

The force of the injury that fractures multiple ribs most likely will injure the underlying lung resulting in a pulmonary contusion.

Question 3

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

Accepted Answer

A flail chest can be caused by blunt injury, trauma incurred in an MVA, and falls from heights.

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

Accepted Answer

Among the conditions that may result with a flail chest are the development of a pneumothorax and the development of a secondary pneumonia.

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)

Accepted Answer

Appropriate pain management is needed with a flail chest injury. Mechanical ventilation with PEEP will stabilize the chest and provide ventilatory support.

Question 6

Which of the following accurately describes a flail chest?

Accepted Answer

A flail chest is defined as double fractures of three or more 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?

Accepted Answer

A flail segment of a flail chest would move inward during inspiration, opposite of normal chest wall movement.

Question 8

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

Accepted Answer

The abnormal movement of gas from one lung to the other is termed pendelluft and may occur with a flail chest.

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

Accepted Answer

Pendelluft is the movement of air from one lung to the other and results in hypoventilation and the rebreathing of dead-space gas.

Question 10

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

Accepted Answer

Paradoxical chest movement means that the flail area moves in the opposite direction from which it normally would. So, with inspiration, the flail area moves inward, and with exhalation, the flail area moves outward. The tracheal position is not affected by broken ribs.

Question 11

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

Accepted Answer

Although full bone healing will not be complete, 5 to 10 days of ventilatory support should allow sufficient healing of the flail area.

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?

Accepted Answer

With a mild flail chest, an increased pH and a decreased SaO₂ would be expected. The patient would be expected to initially have alveolar hyperventilation with hypoxemia.

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

Accepted Answer

Chest radiograph findings would be expected to include multiple rib fractures and increased opacity of the lung area with compression and atelectasis.

Question 14

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

Accepted Answer

Compression of the lung tissue occurs beneath the flail section and atelectasis results. The atelectasis then results in a decreased ventilation/perfusion ratio leading to increased venous admixture. Hypoxemia will occur.

Question 15

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

Accepted Answer

With a flail chest, the patient's breath sounds will be diminished on both the affected and unaffected sides.

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

Accepted Answer

When a flail chest is present, pain and anxiety, stimulation of J receptors, and activation of deflation receptors and irritant receptors may all contribute to an increased respiratory rate.

Quiz 22: Flail Chest

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

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

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

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

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)