NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaEasy
A 55-year-old male was involved in a fall from a ladder, landing on his side. He complains of sharp pain in his right upper quadrant and difficulty breathing. Upon examination, you note bruising to the right lateral chest wall and paradoxical motion of a segment of ribs during respiration. Which of the following is the MOST appropriate initial management for this patient's respiratory compromise?
- AAdminister high-flow oxygen via non-rebreather mask only.
- BApply a tight circumferential bandage around the chest.
- CStabilize the paradoxical segment with a bulky dressing and tape.
- DPerform needle decompression of the right chest.
Show answer & explanationAnswer & explanation
Correct answer: C. Stabilize the paradoxical segment with a bulky dressing and tape.
The patient presents with signs of a flail chest, indicated by paradoxical motion of a rib segment. Stabilizing this segment with a bulky dressing and tape helps improve respiratory mechanics and reduce pain, which is the most appropriate initial management for the respiratory compromise caused by the flail segment.
Why the other options are wrong
- A. While oxygen is important, it does not address the mechanical issue of the flail segment, which is contributing to the respiratory compromise.
- B. Applying a tight circumferential bandage can restrict chest expansion, worsening respiratory distress, and is contraindicated for flail chest.
- D. Needle decompression is used for tension pneumothorax, which is not directly indicated by the patient's presentation of paradoxical motion, although it could be a secondary complication.
Flail Chest Management
Flail chest occurs when three or more adjacent ribs are fractured in two or more places, causing a segment of the chest wall to move independently (paradoxically) during respiration. Initial management focuses on stabilizing this segment.
- Paradoxical motion is key sign.
- Stabilization improves breathing and pain.
- Oxygen is supportive care.
Memory trick: Flipping Ribs, Stabilize to Breathe.