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Rib fx, Flail chest Flashcards

1
Q

______ are the most common injury sustained in blunt thoracic trauma

A

Rib Fx

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2
Q

True/False

Rib Fractures are usually not sustained in motor vehicle accidents.

A

False

usually sustained from MVA

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3
Q

True/False

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

A

True

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4
Q

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.

A

Rib Fx

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4
Q

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.

A

Rib Fx

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5
Q

True/false

Mortality decreases with the number of ribs involved.

A

False

Increases

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6
Q

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

A

CXR

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7
Q

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

A

50

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8
Q

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

A

complications

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9
Q

DDx for Rib Fx

A

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

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10
Q

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

A

Rapid mobilization
respiratory support
pain management

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11
Q

Rib FX

_____ is paramount in facilitating adequate ventilation

A

Pain control

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12
Q

True/False

Incentive spirometry is excellent supportive therapy in stable patients.

A

True

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13
Q

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

A

respiratory failure

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14
Q

Rib Fx

What can help prevent hypoventilation and atelectasis?

A

Continuous body positioning and oscillation therapy

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15
Q

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

A

False

should be considered

16
Q

Rib Fx Disposition

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

A

They do not require routine admittance or serial radiographic studies.

17
Q

Treatment for Rib FX

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

A

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

18
Q

Complications for Rib FX, F

A

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

19
Q

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

A

Flail chest

20
Q

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

  1. inward
  2. outward
A

inward

21
Q

What is usually required to cause flail chest?

A

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

22
Q

What is the major problem from flail chest

A

respiratory failure due to the underlying pulmonary injury

23
Q

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.

A

flail chest

24
Q

True/false

Labs are contributory to dx for Flail chest

A

False

Noncontributory – Dx made based on history and physical exam

25
Q

True/False

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

A

True

26
Q

DDx for Flail chest

A

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

27
Q

What is the diference between flail chest and rib fx

A

Flail chest- Respiratory distress,

28
Q

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

A

True

29
Q

What is the first line Tx for flail chest?

A

Supplemental oxygen

30
Q

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

A

O2 therapy

31
Q

What can you use for pain controll for Flail chest?

A

IV Morphine 2-8 mg

IV Fentanyl 50-100 mcg 1-2h prn

32
Q

Flail chest pt

Indications for early ventilation would include……

A

marked hypoxia

inadequate breathing

33
Q

Approximately ___% of patients will need immediate intubation

A

50%

34
Q

True/False

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

A

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

35
Q

Disposition for Flail chest patients

A

MEDEVAC

resp (22 decks)

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