Paramedic National Registry Practice

In a patient with a flail segment and coughing blood, what condition might you suspect?

1. Rib fracture

2. Pneumothorax

3. Pulmonary contusion

4. Hemothorax

The correct answer is: Pulmonary contusion

In a patient presenting with a flail segment and coughing blood, the most consistent condition you would suspect is a pulmonary contusion. A flail segment is typically a result of multiple rib fractures where a section of the chest wall becomes detached. This can often lead to significant compromise of lung function in the affected area. When a patient exhibits coughing blood, this can indicate trauma to the lung tissue itself, which is characteristic of a pulmonary contusion. This condition arises when the lung is bruised due to blunt force trauma, causing bleeding within the lung tissues, which then can present as blood in the sputum. While rib fractures can cause pain and respiratory distress, they typically do not directly lead to coughing up blood unless there is an associated injury to the lung. Pneumothorax, which involves air in the pleural space, can cause respiratory distress and sometimes result in blood from other injuries, but it’s generally not the primary cause of coughing up blood. Hemothorax involves blood accumulation in the pleural cavity but is less likely to directly result in a productive cough of blood as compared to the local lung tissue damage seen with a pulmonary contusion.