NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaMedium
A 25-year-old male was involved in a motor vehicle collision and is presenting with paradoxical motion of a segment of his chest wall, severe pain, and dyspnea. His blood pressure is 100/60 mmHg, heart rate 110 bpm, and respiratory rate 28 bpm. What is the MOST immediate and appropriate intervention for this patient?
- AApply a non-rebreather mask and assist ventilations with a BVM.
- BAdminister high-flow oxygen and stabilize the flail segment with a bulky dressing.
- CPrepare for immediate needle decompression of the chest.
- DInitiate rapid transport to the nearest trauma center without further intervention.
Show answer & explanationAnswer & explanation
Correct answer: B. Administer high-flow oxygen and stabilize the flail segment with a bulky dressing.
The patient's symptoms (paradoxical motion, dyspnea, pain) are classic for a flail chest. The immediate priorities are to ensure adequate oxygenation and stabilize the flail segment to improve ventilation and reduce pain. A bulky dressing can help stabilize the segment.
Why the other options are wrong
- A. While oxygen is needed, assisting ventilations with a BVM is typically reserved for patients with inadequate breathing, which isn't explicitly stated as inadequate, but paradoxical motion indicates ineffective breathing.
- C. Needle decompression is used for tension pneumothorax, which is not indicated by the provided symptoms alone, though flail chest can lead to it.
- D. While rapid transport is crucial, immediate on-scene interventions to support breathing and stabilize the injury are necessary before transport.
Flail Chest Management
Flail chest occurs when three or more adjacent ribs are fractured in two or more places, creating a free-floating segment of the chest wall.
- Characterized by paradoxical motion of the chest wall.
- Impairs ventilation and gas exchange.
- Primary treatment involves oxygen and stabilization of the flail segment.
Memory trick: Flail chest, oxygen high, stabilize the segment, don't let them sigh.