Which sequence correctly lists the chest assessment steps after a fire, from first to last?

• A. Inspect the chest for paradoxical movements; Palpate the sternum, clavicles, and ribs; Auscultate breath sounds and heart sounds; Evaluate for rib fractures and cardiac injury; Obtain imaging.
• B. Inspect the chest for paradoxical movements; Obtain a chest X-ray and 12-lead ECG; Palpate the sternum, clavicles, and ribs; Auscultate breath sounds and heart sounds; Evaluate.
• C. Palpate the sternum, clavicles, and ribs; Inspect the chest; Auscultate breath sounds and heart sounds; Evaluate; Obtain imaging.
• D. Auscultate breath sounds and heart sounds; Inspect the chest; Palpate; Evaluate; Obtain imaging.

Answer: (A)

In chest assessment after a fire, start with a structured secondary survey to catch life-threatening injuries early. Begin by visually inspecting the chest for symmetry and any paradoxical movements, since a chest wall that moves opposite with breathing can signal a serious injury like a flail chest and urgent action may be needed. Next, palpate the sternum, clavicles, and ribs to check for tenderness, deformities, crepitus, or instability, which helps localize injuries and gauge the extent of trauma. Then listen to breath sounds and heart sounds to assess airflow and circulation, looking for signs of pneumothorax, hemothorax, contusions, or possible cardiac injury. With these findings in mind, evaluate for rib fractures and cardiac injury and determine whether imaging is necessary to confirm injuries and guide treatment. Imaging is then obtained to document and further evaluate the suspected injuries.