When assessing a trauma patient’s chest, you should remember that: the presence of hyporesonance to percussion is an indicator of air trapping in the pleural space. a structurally nonintact chest wall should be stabilized by circumferentially wrapping the chest with bandages. breath sounds should be assessed routinely in at least two fields prior to visual or tactile assessment. paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms.
The Correct Answer and Explanation is :
The correct answer is: Paradoxical movement may not be grossly apparent due to the splinting effect of chest muscle spasms.
Explanation: When assessing a trauma patient’s chest, it is essential to consider a variety of signs that can help identify life-threatening conditions, particularly those that affect the breathing and stability of the chest wall. Paradoxical movement refers to the abnormal movement of the chest wall during respiration, where the affected area moves in the opposite direction of the rest of the chest during inspiration and expiration. This is a classic sign of a flail chest, which occurs when multiple adjacent ribs are fractured in two or more places, leading to a free-floating segment of the chest wall.
However, paradoxical movement may not always be readily apparent due to muscle spasms. Chest muscle spasms are often a response to pain and trauma, and they can “splint” or restrict the movement of the chest wall. This can prevent the abnormal, paradoxical movement from being easily observed. As a result, while paradoxical movement is a key clinical sign of a flail chest, the splinting effect of spasms may mask or reduce its gross visibility.
The other statements in the question are also important considerations in trauma chest assessment:
- Hyporesonance to percussion indicates the presence of fluid or air in the pleural space, such as in pneumothorax (air) or hemothorax (blood). This is different from hyperresonance, which is usually indicative of a pneumothorax.
- Stabilizing a nonintact chest wall is critical in preventing further movement that may worsen the injury. However, wrapping the chest with bandages can impede breathing and is not generally recommended. Instead, techniques like using a bulky dressing or splinting are preferred.
- Breath sounds should be assessed in multiple fields to identify any abnormal findings like decreased or absent sounds, which can point to conditions like pneumothorax or hemothorax. Visual or tactile assessments are also important but should not replace auscultation.
Thus, assessing paradoxical movement and understanding the effects of muscle spasms is crucial in the evaluation of chest trauma.