Question

Case Study 1.

Andrew, a 22-year-old male, was involved in a head-on collision. He was not wearing his

seatbelt at the time of the accident. When emergency crews reached the scene of the accident

they found Andrew wedged against the steering wheel. Following a difficult extraction from his

vehicle, Andrew is exhibiting the following symptoms:

- Semiconscious

- Dyspnea

- Inward movement of the left anterior portion of his thorax during inhalation

- Pain in his left thorax and upper left abdomen

- Pale and cyanotic mucous membranes and cyanotic areas around his upper lip and nail beds

- BP 83/51

- CBC HgB 10.1, HcT 30%

- Blood chemistry abnormalities Arterial PO2 65mmHg, Arterial PCO2 55mmHg, Arterial pH 7.27

- Urinalysis: pH 4.0

1. What is the most likely cause of Andrew’s symptoms?

2. Flail chest is a condition which occurs when one section of the ribcage moves inward while

the rest of the thoracic wall moves outward during inhalation. What might be the cause of this

condition?

3. How might this condition affect the breathing process?

4. Why does Andrew have cyanotic mucous membranes?

Answer 1

1.Here the patient met with an accident, he was no weared the helmet and head hit during accident. Thus patient mostly experinced head injury and trauma to the chest.

Possibly Head injury and Flail chest,because of this patient having this symptoms.

Patient is semiconcious and having dyspnoea.

Flail chest is manifested by

• Paradoxical movement of a portion of chest wall.
• Extreme pain.
• Dyspnoea.

2.Flail chest caused by blunt trauma,followed by an vehicle accident.It is also caused by bone disease and bone deterioration.

Here the patient met with an accident and flail chest occurs.

Flail chest is a life threatening condition,in this segment of ribcage is breakdown followed by chest trauma and detached from the chest wall.

Because of this reason paradoxical chestmovement occurs.

3.Flail chest can cause negative impact on respiration by different ways.

• Ineffective ventilation- It is caused by incresed dead space and decressed intra thoracic preassure and thus incresed demand for oxygen by injured tissue.
• Pulmonary contusion-It cause swelling ,hemorrhage ,and gradually necrosis of tissue.
• Hypoventilation and Atlectasis occur as a result of pain and injury.

4.Cyanosis means bluish discoloration of skin and mucous membrane.Here the patient experinces impaired tissue perfusion due to flail chest and cyanosis of mucous membrane occurs.

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