STUDY - Technical - New Dacian's Medicine
Chest
expansion, asymmetrical (Classical / Allopathic Medicine)
Asymmetrical chest
expansion is the uneven extension of portions of the chest
wall during inspiration. During normal respiration, the thorax
uniformly expands upward and outward and then contracts
downward and inward. When this process is disrupted, breathing
becomes uncoordinated, resulting in asymmetrical chest
expansion.
Asymmetrical chest
expansion may develop suddenly or gradually and may affect one
or both sides of the chest wall. It may occur as delayed
expiration (chest lag); as abnormal movement during
inspiration (for example, intercostal retractions, paradoxical
movement, or chest-abdomen asynchrony); or as unilateral
absence of movement. This sign usually results from a pleural
disorder, such as life-threatening hemothorax or tension
pneumothorax. However, it can also result from a
musculo-skeletal or urologic disorder, airway obstruction, or
trauma. Regardless of its underlying cause, asymmetrical chest
expansion produces rapid and shallow or deep respirations that
increase the work of breathing.
ALERT:
If you detect asymmetrical chest expansion:
- take the patient's vital signs
- look for signs of acute respiratory distress, and administer oxygen
- use tape or sandbags to temporarily splint the unstable flail segment
- insert an I.V. line for fluid replacement and administration of pain medication
- contact the physician
- have emergency equipment available.
If you don't suspect flail chest, and if the patient isn't experiencing acute respiratory distress, perform a focused assessment.
If you detect asymmetrical chest expansion:
- take the patient's vital signs
- look for signs of acute respiratory distress, and administer oxygen
- use tape or sandbags to temporarily splint the unstable flail segment
- insert an I.V. line for fluid replacement and administration of pain medication
- contact the physician
- have emergency equipment available.
If you don't suspect flail chest, and if the patient isn't experiencing acute respiratory distress, perform a focused assessment.
HISTORY:
Ask the patient if he's experiencing dyspnea or pain during breathing. If so, it is constant or intermittent? Does the pain worsen his feeling of breathlessness? Does repositioning, coughing, or any other activity relieve or worsen his dyspnea or pain? Is the pain more noticeable during inspiration or expiration? Can he inhale deeply?
Review the patient's medical history for pulmonary or systemic illness, blunt or penetrating chest trauma, and thoracic surgery.
Obtain an occupational history to find out if the patient may have inhaled toxic fumes or aspirated a toxic substance.
Ask the patient if he's experiencing dyspnea or pain during breathing. If so, it is constant or intermittent? Does the pain worsen his feeling of breathlessness? Does repositioning, coughing, or any other activity relieve or worsen his dyspnea or pain? Is the pain more noticeable during inspiration or expiration? Can he inhale deeply?
Review the patient's medical history for pulmonary or systemic illness, blunt or penetrating chest trauma, and thoracic surgery.
Obtain an occupational history to find out if the patient may have inhaled toxic fumes or aspirated a toxic substance.
PHYSICAL
ASSESSMENT:
Inspect the neck for ecchymosis, swelling, or hematomas and the face for swelling.
Listen for noisy air movement. Inspect the jugular veins for distention, and gently palpate the trachea for midline positioning.
Examine the posterior chest wall for areas of tenderness or deformity.
Auscultate all lung fields for normal and adventitious breath sounds.
Inspect the neck for ecchymosis, swelling, or hematomas and the face for swelling.
Listen for noisy air movement. Inspect the jugular veins for distention, and gently palpate the trachea for midline positioning.
Examine the posterior chest wall for areas of tenderness or deformity.
Auscultate all lung fields for normal and adventitious breath sounds.
SPECIAL
CONSIDERATIONS:
Asymmetrical chest expansion can result from surgical removal of several ribs.
Asymmetrical chest expansion can result from surgical removal of several ribs.
PEDIATRIC
POINTERS:
Children develop asymmetrical chest expansion, paradoxical breathing, and retractions with acute respiratory illnesses, such as bronchiolitis, asthma, and croup.
Congenital abnormalities, such as cerebral palsy or diaphragmatic hernia, can cause asymmetrical chest expansion.
Children develop asymmetrical chest expansion, paradoxical breathing, and retractions with acute respiratory illnesses, such as bronchiolitis, asthma, and croup.
Congenital abnormalities, such as cerebral palsy or diaphragmatic hernia, can cause asymmetrical chest expansion.
AGING ISSUES:
Asymmetrical chest expansion may be more difficult to determine in an elderly patient because of the structural deformities associated with aging.
Asymmetrical chest expansion may be more difficult to determine in an elderly patient because of the structural deformities associated with aging.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing and treatment. Provide emotional support to the patient and family.
Instruct the patient on what to expect from diagnostic testing and treatment. Provide emotional support to the patient and family.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)