Flail Chest

  1. General information
    1. Fracture of several ribs and resultant instability of the affected chest wall.
    2. Chest wall is no longer able to provide the bony structure necessary to maintain adequate ventilation; consequently, the flail portion and underlying tissue move paradoxically (in opposition) to the rest of the chest cage and lungs.
    3. The flail portion is sucked in on inspiration and bulges out on expiration.
    4. Result is hypoxia, hypercarbia, and increased retained secretions.
    5. Caused by trauma (sternal rib fracture with possible costochondral separations).
  2. Medical management
    1. Internal stabilization with a volume-cycled ventilator
    2. Drug therapy (narcotics, sedatives)
  3. Assessment findings
    1. Severe dyspnea; rapid, shallow, grunty breathing; paradoxical chest motion
    2. Cyanosis, possible neck vein distension, tachycardia, hypotension
    3. Diagnostic tests
      1. pO2 decreased
      2. pCO2 elevated
      3. pH decreased
  4. Nursing interventions
    1. Maintain an open airway: suction secretions/blood from nose, throat, mouth, and via endotracheal tube; note changes in amount, color, characteristics.
    2. Monitor mechanical ventilation.
    3. Encourage turning, coughing, and deep breathing.
    4. Monitor for signs of shock.

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