A 20 years male patients following road traffic accident presented with pulse 100/minute, BP 100/70 mmHg and Respiratory rate 21/minute. The chest move in inspiration and move out in expiration. Diagnosis is
i.e. (Flail chest): (689-Schwartz 7th) (161, 179-190- CSDT 13th)FLAIL CHEST - Massive trauma to the chest with multiple fracture of multiple ribs or bilateral disruption of the costo chondral junctions can result in free floating segment of chest wall may produce a paradoxical motion that impairs lung expansion.Flail chest is characterized by paradoxical motion of the chest wall (inward with inspiration and outward with expiration) The chances of having an intra thoracic injury in this situation increases several folds PaCO2 increases. In addition hypoventilation leads to progressive atelectasis and hypoxemia (and most important consequence of flail chest is respiratory failure).* PaO2: FiO2 ratio yields an estimate of the extent of intrapulmonary shunt and may be used as a parameter to determine the need for mechanical ventilationTreatment* Analgesia intercostal nerve block, epidural anaesthesia* Endotracheal intubation and mechanical ventilation with peak end expiratory pressure are usually indicated provided that pain control is adequate* Intubation is delayed until clear evidence of a need of ventilator suport develops; a respiratory rate of 40/min, a falling PaCO2 (evidence of excessive work of breathing) or a PaO2 below 60 torr or inspired O2 fraction of over 0.5 (689-Schwartz 7th)* Suggested parameters for instituting ventilator support are respiratory rate >30 breaths per minute PaO2 <60 mmHg or PaCO2 >45 mmHg (894-W.Shields 7th)* Open reduction plus internal fixation of sternal or rib fractures is rarely neededTENSION PNEUMOTHORAX - develops when a flap valve leak allows air to enter the pleural space but prevents its escape, intrapleural pressure rises, causing total collapse of the lung and a shift of the mediastinal viscera to the opposite side interfering with venous return to the heart It must be relieved immediately to avoid impairment of cardiac functionsCP- hypotension in the presence of distended neck veins, decreased or absent breath sounds of the affected side hyper resonance to percussion and tracheal shift away from the affected side, cyanosis (late manifestation)Treatment - Insertion of a large bore needle or plastic IV cannula (angiocath) through the chest wall into the pleural space in the second intercostal space in the second intercostal space along the mid clavicular line to relieve pressure. Tension pneumothorax should be treated definitively by tube thoracostomy.Suckling chest wound - which allow air to pass in and out of the pleural cavity should be promptly treated by a three sided occlusive dressing and tube thoracostomy
Flail chest
Tension pneumothrax
Suckling chest wound
Haemothorax
Trauma