Chapter 7 Body Systems

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Chapter 7 Body Systems

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.

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Anatomic Alterations of the Lungs

• Double fracture of numerous adjacent ribs

• Rib instability

• Lung restriction

• Atelectasis

• Lung collapse (pneumothorax)

• Lung contusion

• Secondary pneumonia

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Etiology

• Motor vehicle accident

• Falls

• Blast injury

• Direct compression by a heavy object

• 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

‣ Pneumonic consolidation

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Clinical Data Obtained at the

Patient’s Bedside

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The Physical Examination

Vital Signs

‣ Increased respiratory rate (tachypnea)

• Tachypnea occurs because of the following:

Stimulation of peripheral chemoreceptors

(hypoxemia)

Paradoxical movement of chest wall—see Figure

21-2 and Figure 21-3.

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The Physical Examination (Cont’d)

Vital Signs (Cont’d)

Decreased lung compliance/increased ventilatory

rate relationship

Activation of the deflation receptors

Activation of the irritant receptors

Stimulation of the J receptors

Pain/anxiety

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Figure 21-2. Lateral flail chest with accompanying pendelluft.

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Figure 21-3. Venous admixture in flail chest.

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The Physical Examination

• Vital Signs (Cont’d)

‣ Increased

• Heart rate (pulse)

• Blood pressure

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The Physical Examination

• Cyanosis

• Chest Assessment Findings

‣ Diminished breath sounds—on both the affected

and the unaffected sides

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Clinical Data Obtained from

Laboratory Tests and Special

Procedures

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Pulmonary Function Test Findings

Moderate to Severe

(Restrictive Lung Pathophysiology)

Lung Volume & Capacity Findings

VT IRV ERV RV VC

N or

IC FRC TLC RV/TLC ratio

N

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Arterial Blood Gases

(Mild to Moderate Flail Chest)

Acute Alveolar Hyperventilation with Hypoxemia

(Acute Respiratory Alkalosis)

pH PaCO 2 HCO 3 PaO 2

(slightly)

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PaO 2 and PaCO 2 trends during acute alveolar hyperventilation.

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Arterial Blood Gases

(Severe Flail Chest)

Acute Ventilatory Failure with Hypoxemia

(Acute Respiratory Acidosis)

pH PaCO 2 HCO 3 PaO 2

(Slightly)

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PaO 2 and PaCO 2 trends during acute or chronic ventilatory failure.

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Oxygenation Indices

Q S /Q T DO 2 VO 2 C(a-v)O 2 O 2 ER SvO 2

N (Severe)

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Hemodynamic Indices

Severe Flail Chest

CVP RAP PA PCWP CO SV


SVI CI RVSWI LVSWI PVR SVR


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Radiologic Findings

• Chest radiograph

‣ Increased opacity

‣ Rib fractures

‣ Increased density on the affected side

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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).

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Respiratory Care Treatment

In mild cases:

Protocols

• Medication for pain and routine bronchial

hygiene

Severe cases

• Volume-controlled ventilation with PEEP

‣ 5 to 10 days usually adequate for sufficient bone

healing

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Respiratory Care Treatment

Protocols (Cont’d)

• Oxygen Therapy Protocol

• Lung Expansion Therapy Protocol

• Mechanical Ventilation Protocol

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