Chapter 21 Flail Chest Figure 21 1 Flail

$Chapter 21 Flail Chest Figure 21 -1. Flail chest. Double fractures of three or$

$Anatomic Alterations of the Lungs Slide 2 Double fracture of numerous adjacent ribs Rib$

Etiology Slide 3 Direct compression by a heavy object Automobile accident Industrial accident Copyright

Overview of the Cardiopulmonary Clinical Manifestations Associated with FLAIL CHEST The following clinical manifestations

Figure 9 -7. Atelectasis clinical scenario. Slide 5 Copyright © 2006 by Mosby, Inc.

Figure 9 -8. Alveolar consolidation clinical scenario. Slide 6 Copyright © 2006 by Mosby,

Clinical Data Obtained at the Patient’s Bedside Vital signs Increased respiratory rate Ø Stimulation

Figure 21 -2. Lateral flail chest with accompanying pendelluft. Slide 8 Copyright © 2006

Figure 21 -3. Venous admixture in flail chest. Slide 9 Copyright © 2006 by

Clinical Data Obtained at the Patient’s Bedside Paradoxic movement of the chest wall Cyanosis

Clinical Data Obtained from Laboratory Tests and Special Procedures Slide 11 Copyright © 2006

Pulmonary Function Study: Lung Volume and Capacity Findings VT Slide 12 RV FRC TLC

Arterial Blood Gases Mild to Moderate Flail Chest p. H Slide 13 Acute alveolar

Time and Progression of Disease Onset Alveolar Hyperventilation 100 90 Pa. O 2 or

Arterial Blood Gases Severe Flail Chest Acute ventilatory failure with hypoxemia p. H Slide

Time and Progression of Disease Onset Alveolar Hyperventilation Acute Ventilatory Failure 100 90 Pa

Oxygenation Indices QS/QT D O 2 V O 2 Normal O 2 ER Slide

Hemodynamic Indices (Severe Flail Chest) Slide 18 CVP RAP PA PCWP CO SV SVI

Figure 21 -4. A, Chest X-ray film of a 20 -year-old female with a

General Management of Flail Chest Mild cases Medication for pain and routine bronchial hygiene

General Management of Flail Chest Respiratory care treatment protocols Slide 22 Oxygen therapy protocol

Slides: 22

Download presentation

$Chapter 21 Flail Chest Figure 21 -1. Flail chest. Double fractures of three or$

Chapter 21 Flail Chest Figure 21 -1. Flail chest. Double fractures of three or more adjacent ribs produce instability of the chest wall and paradoxical motion of the thorax. Inset, Atelectasis, a common secondary anatomic alteration of the lungs. Slide 1 Copyright © 2006 by Mosby, Inc.

$Anatomic Alterations of the Lungs Slide 2 Double fracture of numerous adjacent ribs Rib$

Anatomic Alterations of the Lungs Slide 2 Double fracture of numerous adjacent ribs Rib instability Lung restriction Atelectasis Lung collapse Lung contusion Secondary pneumonia Copyright © 2006 by Mosby, Inc.

Overview of the Cardiopulmonary Clinical Manifestations Associated with FLAIL CHEST The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Atelectasis (see Figure 9 -7) and Pneumonic Consolidation (see Figure 9 -8)— the major anatomic alterations of the lungs associated with flail chest (see Figure 21 -1). Slide 4 Copyright © 2006 by Mosby, Inc.

Clinical Data Obtained at the Patient’s Bedside Vital signs Increased respiratory rate Ø Stimulation of peripheral chemoreceptors Ø Other possible mechanisms • • • Slide 7 Decreased lung compliance Activation of the deflation receptors Activation of the irritant receptors Stimulation of the J receptors Pain/anxiety Increased heart rate, cardiac output, blood pressure Copyright © 2006 by Mosby, Inc.

Clinical Data Obtained at the Patient’s Bedside Paradoxic movement of the chest wall Cyanosis Chest assessment findings Ø Slide 10 Diminished breath sounds • On the affected as well as the unaffected side Copyright © 2006 by Mosby, Inc.

Time and Progression of Disease Onset Alveolar Hyperventilation 100 90 Pa. O 2 or Pa. CO 2 80 Point at which Pa. O 2 declines enough to stimulate peripheral oxygen receptors 70 60 Pa. O 2 50 40 30 20 Pa. C O 2 10 0 Slide 14 Figure 4 -2. Pa. O 2 and Pa. CO 2 trends during acute alveolar hyperventilation. Copyright © 2006 by Mosby, Inc.

Time and Progression of Disease Onset Alveolar Hyperventilation Acute Ventilatory Failure 100 90 Pa 02 or Pa. C 02 80 70 60 Point at which Pa. O 2 declines enough to stimulate peripheral oxygen receptors Point at which disease becomes severe and patient begins to become fatigued O a. C 2 P 50 40 30 Pa O 2 20 10 0 Figure 4 -7. Pa. O 2 and Pa. CO 2 trends during acute ventilatory failure. Slide 16 Copyright © 2006 by Mosby, Inc.

Figure 21 -4. A, Chest X-ray film of a 20 -year-old female with a severe right-sided flail chest. B, Close-up of the same X-ray film, demonstrating rib fractures (arrows). Slide 20 Copyright © 2006 by Mosby, Inc.

General Management of Flail Chest Mild cases Medication for pain and routine bronchial hygiene Severe cases Volume-controlled ventilation with PEEP Ø Slide 21 5 to 10 days usually adequate for sufficient bone healing Copyright © 2006 by Mosby, Inc.