Flail chest

FLAIL CHEST MANAGEMENT

1. Flail chest DR.BANU CHANDER PANDIAN .S DNB FAMILY MEDICINE KG HOSPITAL

2. 6/23/2017 www.health-nurses-doctors.blogspot.com FLAIL CHEST The breaking of 2 or more ribs in 2 or more places, resulting in free- floating rib segments.

3. 6/23/2017 Blunt Trauma - Blunt force to chest. E.g. automobile crashes and falls. Penetrating Trauma - Projectile that enters chest causing small or large hole. E.g. gun shot and stabbing. Compression Injury - Chest is caught between two objects and chest is compressed.

4. TYPE ANTERIOR – Near costochondral region POSTERIOR – safer LATERAL - in ribs shafts

5. 6/23/2017 www.health-nurses-doctors.blogspot.com SYMPTOMS Shortness of Breath Paradoxical Movement Bruising/Swelling Crepitus (Grinding of bone ends on palpation) Tachycardia Hypotension

6. 6/23/2017 PARADOXICAL MOVEMENT The flail portion of the chest is sucked in with inspiration, instead of expanding outward Ballooned out with expiration instead of collapsing inward Hypoventilation and hypoxemia

7. 6/23/2017 www.health-nurses-doctors.blogspot.com Diagnosis: Palpation : crepitus and tenderness near fractured ribs. chest x-ray CT CHEST ABGs

8. ASSESMENT Frequent and prompt Respiratory assessment Adequate oxygenation Analgesia to improve ventilation. Clearing secretion Stabilize the thoracic cage Deep breathing exercises Intubation and mechanical ventilation may be required to prevent further hypoxia 6/23/2017 www.health-nurses-doctors.blogspot.c

9. MANAGEMENT Pain Control Alternative to relieve pain: Intercostal Nerve Blocks Epidural Anesthesia. Wearing a chest binder Maintain IV flow rates Monitor adequate tissue perfusion Anxiety reducing techniques Heath education/teaching 6/23/2017 www.health-nurses-doctors.blogspot.com

10. 6/23/2017 www.health-nurses-doctors.blogspot.com COMPLICATIONS Pneumonia ARDS Lung abscess Emphysema Hypoventilation Atelectasis Mediastinal flutter ( mediastinal structures tend to swing back n forth)

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