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).