Flail Chest Chapter 21

What is flail chest?
What is flail chest?
double fractures of three or more adjacent ribs

What does flail chest produce?
-instability of the chest wall and paradoxic motion of the thorax.
-the lung also may be contused (bruised) under the fractured ribs

What happens to the affected flail ribs?
What happens to the affected flail ribs?
they cave in (flail) during inspiration as a result of the subatmospheric intrapleural pressure.

Flail chest can cause what type of lung disorder?
restrictive

The major pathologic or structural changes of the lungs associated with flail chest are?
-double fracture of numerous adjacent ribs
-rib instability
-lung volume restriction
-atelectasis
-lung collapse (pneumothorax)
-lung contusion
-secondary pneumonia

A blunt or crushing injury of the chest is usually the cause of?
flail chest

What is used to stabilize a flail chest?
volume controlled ventilation, accompanied by (PEEP) positive end-expiratory pressure

For how many days is mechanical ventilation used on a patient with flail chest?
5 to 10 days

Flail oxygen therapy protocol is used to?
-treat hypoxemia
-decrease work of breathing
-decrease myocardial work

Hypoxemia that develops in flail chest is most commonly caused by?
alveolar atelectasis and capillary shunting

What is pendelluft
the shunting of air from one lung to another

Venous Admixture
is admixture of oxygenated (ventilated alveolus) blood with unoxygenated (hypoventilated alveolus) blood.

Vital signs in flail chest include
-increased respiratory rate (tachypnea)
-paradoxic movement of the chest wall
-increased heart rate (pulse) or blood pressure

Increased ventilator rate can be caused by?
-stimulation of the chemoreceptors (hypoxemia)
-paradoxic movement of the chest wall

In flail chest trauma, during inspiration the fractured ribs are?
pushed inward by the atmospheric pressure surrounding the chest and negative intrapleural pressure

In flail chest trauma, during expansion the fractured ribs are?
the flail area bulges outward when the intrapleural pressure becomes greater than the atmospheric pressure

A person with flail chest will have abnormal chest and lung movement (paradoxic movement) that will cause airto?
will cause air to be shunted from one lung to another during a ventilator cycle.

During pendelluft the patient rebreathes?
dead space gas and hypoventilates

Pendelluft produces what type of ventilation?
hypovetilaion

During pendelluft, what my also decrease by the lung compression and atelectasis associated with the unstable chest wall?
alveolar ventilation

V/Q ratio decreases as a result of?
pendelluft, lung compression, and atelectasis

Because of venous admixture, the patient’s ?
PaO2 and CaO2 decrease

Lung sounds in flail chest will be?
diminished on both the affected and the unaffected sides

Chest radiograph (x-ray) on a flail chest will show?
-increased opacity (whiter)
-the density of the lung of the affected side increases

Paradox movement of chest wall
during inspiration the fractured ribs are pushed inward by atmospheric pressure surrounding the chest and negative intrapleural pressure. during exhalation the flail area bulges outward when the intrapleural pressure becomes greater than the atmospheric pressure.

Pendelluft
the shunting of air from one lung to another

PEEP
positive end-expiratory pressure

In flail chest, the following will occur?
2. Atelectasis
3. Intrapulmonary shunting occurs

When the patient has a severe flail chest, the following will occur?
2. Cardiac output decreases
3. Central Venous pressure increases

A flail chest consists of a double fracture of at least?
three adjacent ribs

As a consequence of severe flail chest, the following will occur?
2. Vt decreases
4. FRC decreases

When mechanical ventilation is used to stabilize a flail chest, how much time generally is needed for adequate bone healing to occur?
5 to 10 days

A flail chest is defined as:
double fractures of 3 or more adjacent ribs

Overall, how would a flail chest affect lung function?
Restrictive lung disorder

Major pathologic and structural changes associated with a flail chest include:
Major pathologic and structural changes associated with a flail chest include:

A flail chest is usually caused by:
blunt or crushing chest injury

Your patient was in an automobile crash and has a mild flail chest injury. What is likely to be needed?
Pain medication

Treatment of a patient with a flail chest will normally include:
1. giving a medication to relieve pain
2. supplemental oxygen
3. mechanical ventilation with PEEP

Your patient with a flail chest has atelectasis on the affected side. What should be implemented to correct the problem?
Hyperinflation therapy protocol

Your patient with a flail chest has paradoxical chest movement. What would be seen with this?
During a cough the flail area bulges out

With paradoxical chest movement there can be the movement of air from one lung to another. This is called:
pendelluft

Which of the following pathophysiologic mechanisms may be activated as a result of a flail chest and increase the patient’s respiratory rate?
3. Activation of the deflation reflex
4. Stimulation of the peripheral chemoreceptors

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