NREMT Paramedic Cognitive ExamTraumaMedium
A 28-year-old male is involved in a high-speed motor vehicle collision. On assessment, he is conscious but disoriented. He has paradoxical chest wall movement on the left side, crepitus over the ribs, and diminished breath sounds on the left. His vital signs are BP 100/60 mmHg, HR 118 bpm, RR 28 breaths per minute. Which of the following conditions is MOST likely present?
- AFlail chest
- BTension pneumothorax
- CSimple pneumothorax
- DPericardial tamponade
Show answer & explanationAnswer & explanation
Correct answer: A. Flail chest
The patient's presentation with paradoxical chest wall movement, crepitus over the ribs, and diminished breath sounds following a high-speed collision is classic for a flail chest. This condition results from the fracture of three or more adjacent ribs in two or more places, leading to a segment of the chest wall that moves independently.
Why the other options are wrong
- B. Tension pneumothorax would typically present with severe respiratory distress, tracheal deviation (late sign), and absent breath sounds, often with JVD and profound hypotension.
- C. A simple pneumothorax would cause diminished breath sounds and possibly respiratory distress, but not paradoxical chest wall movement.
- D. Pericardial tamponade would present with Beck's triad (JVD, muffled heart tones, hypotension) and pulsus paradoxus, not paradoxical chest wall movement.
Flail Chest
A condition in which three or more adjacent ribs are fractured in two or more places, resulting in a segment of the chest wall that moves paradoxically to the rest of the chest during respiration.
- Caused by blunt chest trauma.
- Hallmark sign is paradoxical chest wall movement.
- Often associated with underlying pulmonary contusion.
Memory trick: CRASH: Chest Ribs Airway Shock, Heart