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CHEST/THORACIC SKELETAL INJURY (CLINICAL SIGNS AND SYMPTOMS (Tachypnea,…
CHEST/THORACIC SKELETAL INJURY
ETIOLOGY
Penetrating injury
Knife wound
Gunshot wound
Blunt injury
Moter vehicle accident (MVA)
Falls
Sports injuries
Crush injuries
Explosives
Caused primarily by the rapid deceleration that occurs with direct impact or blow to the thorax
PATHOPHYSIOLOGY
Double fractures of numerous adjacent ribs
Rib instability
Lung volume restriction
Atelectasis
Lung collapse (pneumothorax)
Lung contusion (bruise)
Secondary pneumonia (from weak cough due to pain)
DIAGNOSTIC TESTING
CXR
Increased opacity (atelectasis in areas with post-flail pneumonia
Rib fractures
Increased density
Bronchoscopy
CT scan
DIFFERENTIAL DIAGNOSIS
Rib fractures on CXR
Flail movement of the chest
CLINICAL SIGNS AND SYMPTOMS
Tachypnea
Paradoxical movement of the chest wall
Pendelluft
- The shunting of gas from one lung to another - Lung of the affected side is compressed during inspiration, gas moves into the lung on the unaffected lung moves into the affected lung - The patient rebreathe dead-space and hypoventilates
Increased HR
Hypertension
Cyanosis
BS: Diminished, both lungs
Pain, anxiety
REPIRATORY MANAGEMENT
Oxygen therapy
Treat hypoxia
Decrease WOB
Decrease myocardial work
Lung expansion therapy
Offset and prevent alveolar consolidation and atelectasis
Mechanical ventilation
Acute ventilatory failure is associated with flail chest, MV and PEEP is often required to maintain adequate ventilation
Flail Chest
- Double fractures of at least 3 or more adjacent ribs, which cause the thoracic cage to become unstable /flail
The affected rib cave in (
flail
) during inspiration as a result of the generated sub atmospheric pressure