Transcript Chapter 7 Body Systems - Kingwood Application Server

Part V
Chest and Pleural Trauma
Slide 1
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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 2
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Anatomic Alterations of the Lungs
Slide 3

Double fracture of numerous adjacent ribs

Rib instability

Lung restriction

Atelectasis

Lung collapse

Lung contusion

Secondary pneumonia
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Etiology
Slide 4

Direct compression by a heavy object

Automobile accident

Industrial accident
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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 5
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Figure 9-7. Atelectasis clinical scenario.
Slide 6
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Figure 9-8. Alveolar consolidation clinical scenario.
Slide 7
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Clinical Data Obtained at the
Patient’s Bedside
Vital signs

Increased respiratory rate

Stimulation of peripheral chemoreceptors

Other possible mechanisms
•
•
•
•
•

Slide 8
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
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Figure 21-2. Lateral flail chest with accompanying pendelluft.
Slide 9
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Figure 21-3. Venous admixture in flail chest.
Slide 10
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Clinical Data Obtained at the
Patient’s Bedside

Paradoxic movement of the chest wall

Cyanosis
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Chest assessment findings

Slide 11
Diminished breath sounds
• On the affected as well as the unaffected side
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Clinical Data Obtained from
Laboratory Tests and Special
Procedures
Slide 12
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Pulmonary Function Study:
Lung Volume and Capacity Findings
VT
Slide 13
RV
FRC
TLC
N or 



VC

IC

ERV

RV/TLC%
N
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Arterial Blood Gases
Mild to Moderate Flail Chest

pH

Slide 14
Acute alveolar hyperventilation with
hypoxemia
PaCO2

HCO3 (Slightly)
PaO2

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Time and Progression of Disease
Disease Onset
Alveolar Hyperventilation
100
90
PaO2 or PaCO2
80
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
70
60
PaO2
50
40
30
20
10
0
Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.
Slide 15
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Arterial Blood Gases
Severe Flail Chest

Acute ventilatory failure with hypoxemia
pH

Slide 16
PaCO2

HCO3 (Slightly)
PaO2

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Time and Progression of Disease
Disease Onset
Alveolar Hyperventilation
Acute Ventilatory Failure
100
90
Pa02 or PaC02
80
70
Point at which PaO2
declines enough to
stimulate peripheral
oxygen receptors
Point at which disease
becomes severe and patient
begins to become fatigued
60
50
40
30
20
10
0
Figure 4-7. PaO2 and PaCO2 trends during acute ventilatory failure.
Slide 17
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Oxygenation Indices
QS/QT
DO2
VO2


Normal
O2ER

Slide 18
C(a-v)O2
(severe)
SvO2

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Hemodynamic Indices
(Severe Flail Chest)
Slide 19
CVP
RAP
PA
PCWP




CO
SV
SVI
CI




RVSWI
LVSWI
PVR
SVR




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Radiologic Findings
Chest radiograph
Slide 20
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Increased density

Rib fractures
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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 21
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General Management of
Flail Chest
Mild cases

Medication for pain and routine bronchial
hygiene
Severe cases

Volume-controlled ventilation with PEEP

Slide 22
5 to 10 days usually adequate for sufficient bone
healing
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General Management of
Flail Chest
Respiratory care treatment protocols
Slide 23

Oxygen therapy protocol

Hyperinflation therapy protocol

Mechanical ventilation protocol
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Classroom Discussion
Case Study: Flail Chest
Slide 24
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