NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaMedium
A 55-year-old male was involved in a head-on motor vehicle collision. He complains of chest pain and difficulty breathing. Upon examination, you note paradoxical motion of a segment of his anterior chest wall. This finding is characteristic of:
- AFlail chest
- BCardiac tamponade
- CHemothorax
- DPneumothorax
Show answer & explanationAnswer & explanation
Correct answer: A. Flail chest
Paradoxical motion of a chest wall segment (moving inward on inspiration and outward on expiration) is the hallmark sign of a flail chest, which occurs when three or more adjacent ribs are fractured in two or more places.
Why the other options are wrong
- B. Cardiac tamponade involves fluid around the heart, causing muffled heart sounds, JVD, and hypotension (Beck's Triad), not paradoxical chest motion.
- C. Hemothorax involves blood in the pleural space, leading to diminished breath sounds and signs of shock, not paradoxical chest wall motion.
- D. Pneumothorax involves air in the pleural space and typically causes diminished or absent breath sounds and respiratory distress, not paradoxical chest wall motion.
Flail Chest
A condition in which three or more adjacent ribs are fractured in two or more places, creating a free-floating segment of the chest wall that moves paradoxically during respiration.
- Hallmark sign: paradoxical chest wall motion.
- Causes severe pain and impaired ventilation.
- Often associated with underlying lung injury.
- Management includes pain control, positive pressure ventilation if needed.
Memory trick: Flail: Free Segment, Paradoxical Air!