FLAIL CHEST

CLINICAL S/S

ETIOLOGY

DIFFERENTIAL DIAGNOSIS

DIAGNOSTICS TESTS

Cyanosis

Tachypnea, Tachycardia and BP due to hypoxemia

Chest forced inward on inspiration

Chest forced outward on expiration

Decreased Alveolar ventilation

Shunting of venous blood

Tracheal deviation

Diminished BS Bilaterally

Hypoxemia- due to alveolar atelectasis and capillary shunting

Fall

MVA

ABG:

Labs

General Assessment

CXR

*Note- Severe tissue hypoxia will cause pH and HCO3- to be lower then expected for a particular CO2 level when lactic acid is present.

Pneumothorax: Open or closed

RESPIRATORY MANAGEMENT

Mechanical Ventilation Protocol

Pharmacological Agent

Lung Expansion Therapy

Aerosolized Bronchodilator Therapy

Oxygen Therapy

Increased opacities (atelectic areas), rib fractures

MV x 5-10 days for calcification/healing PEEP, ARDS prevention

Tx for hypoxia, decreased WOB and myocardial work, may be refractory to oxygen due to capillary shunting

Tx for atelectasis and consolidation CPAP, PEP, IS, IPPB, Cough & deep bthg

Paralytic agent in severe cases

Pendelluft- shunting of gas from one lung to another

Due to stimulation of the peripheral chemoreceptors

Decreased lung compliance

Pain, anxiety

Paradoxical movement of the chest wall

Mild to Moderate: Inc pH, Dec PaCO2, Dec HCO3-, Dec PaO2, Dec SaO2

Severe: Dec pH, Inc PaCO2, Inc HCO3-, Dec PaO2, Dec PaO2

CBC, lactic acid,

Blast Injury

Direct Compression by heavy object

Occupational/Industrial accidents

Hemodynamics

Inc CVP, Inc RAP, Inc PAP, Inc PVR, Inc RVSWI

PATHOPHYSIOLOGY

Double fracture of numerous adjacent ribs, rib instability, lung volume restriction, atelectasis, lung collapse (pneumothorax), lung contusion (trauma), secondary pneumonia (due to weak cough from pain).