Rib fx, Flail chest

Question 1

______ are the most common injury sustained in blunt thoracic trauma

Answer 1

Rib Fx

Question 2

True/False
Rib Fractures are usually not sustained in motor vehicle accidents.

Answer 2

False
usually sustained from MVA

Question 3

True/False
Fractures of the first rib usually indicate severe trauma because of the necessary force to produce such an injury.

Answer 3

True

Question 4

Physical findings for what?
(1)may cause localized pain, crepitus, pain with inspiration, and dyspnea.
(2) May cause pneumothorax or Hemothorax.
(3) Mortality increases with the number of ribs involved.
(4) The pain associated with rib fractures may lead to hypoventilation, atelectasis, retained secretions, and pneumonia.

Answer 4

Rib Fx

Question 5

True/false
Mortality decreases with the number of ribs involved.

Answer 5

False
Increases

Question 6

______ is the screening tool of choice for the detection of rib fractures,

Answer 6

CXR

Question 7

Up to ___% of rib fractures cannot be detected on CXR.

Answer 7

50

Question 8

X-rays are usually obtained to identify ____, not specifically for rib fractures

Answer 8

complications

Question 9

DDx for Rib Fx

Answer 9

(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych

Question 10

What are the mainstays of treatment for the patient with multiple rib fractures

Answer 10

Rapid mobilization
respiratory support
pain management

Question 11

Rib FX
_____ is paramount in facilitating adequate ventilation

Answer 11

Pain control

Question 12

True/False
Incentive spirometry is excellent supportive therapy in stable patients.

Answer 12

True

Question 13

Mechanical ventilation allows for healing of the ribs and prevention of complications in the patient with ______.

Answer 13

respiratory failure

Question 14

Rib Fx
What can help prevent hypoventilation and atelectasis?

Answer 14

Continuous body positioning and oscillation therapy

Question 15

True/False
Rib Fx disposition
Admission is not usually for elderly or other patients with serious underlying lung disease and isolated rib fractures.

Answer 15

False
should be considered

Question 16

Rib Fx Disposition
Young, healthy patients with isolated rib fractures without evidence of other serious underlying injury.

Answer 16

They do not require routine admittance or serial radiographic studies.

Question 17

Treatment for Rib FX
Young, healthy patients with isolated rib fractures without evidence of other serious underlying injury.

Answer 17

(a) Pain medication.
(b) Deep breathing exercises.
(c) Incentive spirometry.

Question 18

Complications for Rib FX, F

Answer 18

(1) Pneumonia
(2) PTX-Pneumothorax
(3) Hemothorax

Question 19

______occurs when a segment of the chest does not have bony contiguity with the rest of the thoracic cage.

Answer 19

Flail chest

Question 20

When negative intrathoracic pressure is generated on inspiration, the flail segment moves ______, thus reducing tidal volume.

1. inward
2. outward

Answer 20

inward

Question 21

What is usually required to cause flail chest?

Answer 21

Usually a significant blunt force is required, e.g., motor vehicle collision (MVC) or a fall from a height.

Question 22

What is the major problem from flail chest

Answer 22

respiratory failure due to the underlying pulmonary injury

Question 23

PE findings of what?
(1) The two major symptoms of this are MSK chest pain and respiratory distress.
(2) Tachypnea with shallow respirations secondary to pain will be seen.
(3) Paradoxical chest wall movement may not be seen in a conscious patient due to splinting of the chest wall.
(4) Crepitus is often present.
(5) When fatigue or underlying pulmonary injury develops, frank respiratory failure may supervene.

Answer 23

flail chest

Question 24

True/false
Labs are contributory to dx for Flail chest

Answer 24

False
Noncontributory – Dx made based on history and physical exam

Question 25

True/False Flail chest Dx is made based on history and physical exam. If possible, obtain Chest X-ray.

Answer 25

True

Question 26

DDx for Flail chest

Answer 26

(1) Cardiac (2) Pulmonary (3) Trauma (4) GI (5) Musculoskeletal (6) Psych

Question 27

What is the diference between flail chest and rib fx

Answer 27

Flail chest- Respiratory distress,

Question 28

True/false Even with marked Flail Chest the patient may be able to compensate initially for the reduced tidal volume by hyperventilating.

Answer 28

True

Question 29

What is the first line Tx for flail chest?

Answer 29

Supplemental oxygen

Question 30

Use caution in long term ____ therapy with chronic COPD/Emphysema patients

Answer 30

O2 therapy

Question 31

What can you use for pain controll for Flail chest?

Answer 31

IV Morphine 2-8 mg IV Fentanyl 50-100 mcg 1-2h prn

Question 32

Flail chest pt Indications for early ventilation would include......

Answer 32

marked hypoxia inadequate breathing

Question 33

Approximately ___% of patients will need immediate intubation

Answer 33

50%

Question 34

True/False External chest wall supports (taping, sandbags) are indicated for flail chest

Answer 34

False not indicated May reduce pain with movement of flail segment but will reduce vital capacity and may worsen respiratory function

Question 35

Disposition for Flail chest patients

Answer 35

MEDEVAC

Question 36

Physical findings for what? (1)may cause localized pain, crepitus, pain with inspiration, and dyspnea. (2) May cause pneumothorax or Hemothorax. (3) Mortality increases with the number of ribs involved. (4) The pain associated with rib fractures may lead to hypoventilation, atelectasis, retained secretions, and pneumonia.

Answer 36

Rib Fx