Flail Chest

[Epona]

Good afternoon all nurses.com buddies! I had a quick question... studying for my resp. test.

With flail chest, can someone please explain why one gets tachycardia and hypotension??

THANK YOU!!!

[Daytonite, BSN, RN]

Because the person is hypoxic and going into shock. Those are symptoms of both.

[Epona]

great! i got it. i see. it makes sense now. thanks a bunch!

i wanted to add.. it said in my textbook that we help position the person to cough and deep breathe. realistically if they have three or more broken ribs, how are they going to move around and cough and deep breathe and so forth?? i think that would be a bit difficult. not sure how we can really expect this from the patient. seems a stretch with several broken ribs.

[Daytonite, BSN, RN]

Cautiously and with some discomfort. These patients will be dyspneic until chest tubes are inserted.

• http://www.trauma.org/index.php/main/article/399/
  
• http://www.emedicine.com/med/topic2813.htm
  
• http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/Flail%20Chest.htm - medical treatment

[Epona]

THANK YOU Daytonite!

I have another question and I APPRECIATE your help! (I emailed my teacher and have not heard back).... with tension pneumothorax I understand the patient can show resp. alkalosis. Can you please explain why AND which way does the trachea go?? It's tension pneumothorax which is closed so I am thinking away from the affected side. Am I right??

THANK YOU!!

[flightnurse2b, LPN]

THANK YOU Daytonite!

I have another question and I APPRECIATE your help! (I emailed my teacher and have not heard back).... with tension pneumothorax I understand the patient can show resp. alkalosis. Can you please explain why AND which way does the trachea go?? It's tension pneumothorax which is closed so I am thinking away from the affected side. Am I right??

THANK YOU!!

a tension pneumothorax is when the air within the pleural space cannot escape and completely collapses the affected lung. when the pocket of air gets larger, and lung collapses further, the trachea and mediastinum are deviated to the opposite side, causing the pt increased dyspnea and usually they will become cyanotic. tracheal deviation is a late sign of tension pneumothorax and the patient will usually rapidly progress to cardiac and respiratory arrest if the air is not allowed to escape. the pt will usaully have hyperressonance and decreased/absent breath sounds on the affected side and may also have subq emphysema prior to tracheal deviation becoming evident.

hope this helps!

[Epona]

yes! that explains it very well. thank you so much!!

[flychick08]

just a side note to the excellent explantation that flightnurse2b gave....the patient may develop respiratory alkalosis (i think) because they are very tachypniec in an effort to compensate for the collapsed lung (pain causes tachypnea,too). i'd suspect that the alkalosis won't last very long with a pneumothorax or tension pneumo. they can't compensate that long and will flip over to respiratory acidosis despite the tachypnea. one more thing about tension pneumo's.....flightnurse2b is correct! tracheal deviation is a late sign...typically these pts. will also present hypotensive and will have a moi that may lead you to suspect a tension pneumo. good luck to9 you:up: