Prehospital Trauma Life Support (PHTLS) 2025 – 400 Free Practice Questions to Pass the Exam

To assess for a potential flail chest, observing for paradoxical movement of the chest wall during breathing is the most direct and effective method. Flail chest occurs when multiple adjacent ribs are fractured in multiple places, leading to a segment of the chest wall that moves in the opposite direction of the rest of the thoracic cage during inhalation and exhalation. This paradoxical movement is a hallmark sign of flail chest.

By monitoring the movement of the chest wall, you can detect this abnormal pattern, which suggests significant underlying injury to the thoracic structures. In the presence of flail segments, during inhalation, the affected area may be drawn inward while the rest of the chest expands, and during exhalation, it may bulge outward while the rest of the chest contracts. Identifying this pattern is crucial for immediate management and may guide treatment decisions, such as the need for stabilization or the use of positive pressure ventilation.

Other assessment methods, such as listening for abnormal lung sounds, performing chest X-rays, or checking for skin integrity, do not provide the same direct evidence for the presence of flail chest. While these methods contribute to a comprehensive assessment, they are not as specific or immediate in confirming the diagnosis of a flail chest