RCP 470 Flail Chest and Pneumothorax

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?

Flail chest

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

Pulmonary contusion

Which of the following accurately describes a flail chest?

Double fractures of three adjacent ribs

Which of the following are pathologic changes associated with a flail chest?

• Pneumothorax

• Secondary

Which of the following are causes of a flail chest?

• Blast injury

• Motor vehicle accident

• Fall from heights

Which of the following would be recommended for the management of an adult with a severe flail chest?

• pain management ‘

• mechanical ventilation

• Positive end- expiratory pressure

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

5 to 10 days

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

alveolar atelectasis

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

During inspiration, the flail section moves inward

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

Air is shunted from one lung to the other

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?

• Hypoventilation

• Rebreathing dead-space gas

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

Diminished over both lungs

Which of the following chest radiograph findings would be expected for a patient with a flail chest?

• Rib fractures

• Decreased opacity

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

Pendelluft

Which of the following can stimulate an increased respiratory rate when a flail chest is present?

• Activation of deflation

• Activation of irritant receptors

• Stimulation of J receptors

Which of the following initial blood gas results would a respiratory therapist expect to find in a patient with a mild flail chest?

Increased pH and decreased SaO2

Which of the following are anatomic alterations that occur when a person has a pneumothorax?

• The lung on the affected side collapses

• The visceral and parietal pleura separate

• The chest wall moves outward

A pneumothorax manifests itself clinically as a primary_________ disorder.

restricitve

What is the primary cause of hypotension in a patient with a large pneumothorax

Decreased venous return to the heart

According to the way gas enters the pleural space, a pneumothorax will be classified as:

• open

• Closed

A patient had a penetrating knife wound to her chest wall that resulted in a valvular pneumothorax. What is another term for this condition?

Tension pneumothorax

A 17-year-old male has been brought to the hospital because he felt short of breath after being tackled in a football game. A chest radiograph shows a broken rib and a pneumothorax in the right lung with pleural space not in direct contact with the atmosphere. Which of the following conditions would be present?

Closed pneumothorax

A 6-foot-tall, 140-pound, 28-year-old female patient has come to the emergency department with a complaint of a sudden sharp pain in the right upper chest followed by shortness of breath. The pain originated while she participated in deep breathing exercises in a yoga class. The physician has determined that she has a 15% pneumothorax. How should the pneumothorax be classified?

Spontaneous

An iatrogenic pneumothorax may be caused by:

• positive pressure mechanical ventilation

• pleural biopsy

• subclavian vein

A 40-year-old patient requires placement of a thoracostomy chest tube. Which of the following are recommended for the procedure?

Application of -5 cm H2O pressure to the chest tube
2. Use of a No. 28 to 36 French gauge tube
3. Placement of the tube at the apex of the lung

After a patient experienced four pneumothoraces of her right lung over a 24-month period, the physician recommended a procedure to reduce the occurrence of future pneumothoraces. Which procedure would the physician have recommended?

Pleurodesis

A patient has a pneumothorax with a sucking chest wound resulting in the movement of gas from one lung to another. This is called:

pendelluft

Which of the following chest assessment findings would be expected in a patient with a tension pneumothorax?

Tracheal shift away from the affected side

Which of the following hemodynamic indices will be found in a patient with a large hemothorax?

Decreased CO

If the patient has a tension pneumothorax, which of the following chest radiograph findings would be expected?

• Mediastinal shift to the unaffected side

• Increased translucency on the side of the pneumothorax

• atelectasis

A sucking chest wound would be classified as a(n) pneumothorax.

open

Which type of pneumothorax would result from the rupture of bulla on the surface of a lung?

Spontaneous pneumothorax

Which type of untreated pneumothorax is considered to be the most serious?

Tension

Gas can gain entrance to the pleural space

via the lungs through a perforation of the visceral pleura.
2. via the surrounding atmosphere through a perforation of the chest wall and parietal pleura.
3. from gas-forming microorganisms in an empyema in the pleural space.