chest


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chest

 [chest]
barrel chest a rounded, bulging chest with abnormal increase in the anteroposterior diameter, showing little movement on respiration; seen in emphysema, kyphosis, and chronic airflow limitation.
Barrel chest. From Herlihy et al., 2000.
flail chest see flail chest.
funnel chest pectus excavatum.
pigeon chest pectus carinatum.
chest tube a tube inserted into the thoracic cavity for the purpose of removing air or fluid, or both. Chest tubes are attached to a closed drainage system (see illustration) so that normal pressures within the alveoli and the pleural cavity can be restored. These pressures are essential to adequate expansion and reinflation of the lung.

Chest tubes are indicated when the normally airtight pleural space has been penetrated through surgery or trauma, when a defect in the alveoli allows air to enter the intrapleural space, and when there is an accumulation of fluid, as from pleural effusion. The effect of excessive amounts of air and fluid within the pleural space is collapse of the lung and the danger of mediastinal shift.
Patient Care. It is important that those responsible for the personal care of a patient who has chest tubes inserted understand the basic mechanics of inflation and deflation of the lung, and the purpose of the tubes and their location in each patient. In some cases one tube is inserted higher in the thorax (usually in the 2nd intercostal space) to remove air, and a second tube is placed lower (in the 8th or 9th intercostal space) to drain off fluids.

Chest tubes may be connected to a variety of closed drainage systems: a water-seal drainage system with one, two, or three bottles; and a self-contained system such as Pleur-evac. Whatever the type, the purpose of the system is to allow for drainage from the pleural cavity to the outside and at the same time prevent the entry of atmospheric air into the pleural cavity.

Precautions that must be taken in the maintenance of the drainage system are:

1. The bottles and collection apparatus of the system must be kept below the level of the chest to prevent backflow.

2. The lumens of the tubes must be kept open to allow for drainage. If they are obstructed there will be no fluctuation of the fluid level in the glass tube that is connected to the chest tube at one end and kept under water in the bottle at the other end. In the Pleur-evac, the liquid in the chamber should rise on the right side and fall on the left side. If there is evidence that the system is not working properly, this must be attended to immediately. Occlusion of the tubes can lead to a buildup of air and fluids in the pleural cavity and creation of a tension pneumothorax.

3. The system must be a closed (airtight) system. There can be no leaks around connections, and the lower end of the glass tube must remain under water in the bottle.

The amount, color, and consistency of the fluid drainage should be checked at least once each hour for the first 24 hours after surgery. The chest tubes should be milked and stripped every one to two hours to assure patency and adequate drainage. The amount of air being removed is indicated by occasional bubbling in the water-seal chamber. Excessive bubbling may indicate air leaks in the tubing.

An important aspect of patient care is proper positioning to maintain adequate drainage. The positions allowed and the amount of mobility permitted will depend on the patient's surgical diagnosis, the placement of the tube(s), and preference of the attending physician. Frequent turning, coughing, and deep breathing are instituted on a regular basis to avoid serious pulmonary complications. An exception to the rule of turning is the pneumonectomy patient, who is placed in high Fowler's position and not turned for at least 24 hours after surgery. Chest physical therapy and intermittent positive pressure breathing (IPPB) treatments usually are ordered for all patients with chest tubes. Some patients may require a ventilator during the immediate postoperative period.

The patient is observed for signs of respiratory distress and a buildup of air and fluid within the pleural cavity. Early correction of this condition can prevent mediastinal shift. Other signals that demand immediate attention are persistent bubbling in the underwater seal (fluid should fluctuate in the tube as the patient breathes), a drainage through the tube that accumulates at a rate of more than 100 ml per hour, leakage of air at the junctions of the chest tube and tubing and bottles or self-contained unit, and a “putty” appearance caused by the leakage of air into subcutaneous tissues in the upper chest and neck. After a chest tube is removed, the wound is promptly sealed with a sterile petroleum jelly dressing to occlude the opening and prevent entry of air into the pleural space.
 One-, two-, and three-bottle methods for providing a closed drainage system. A, In the one-bottle system the drainage via the chest tube enters the bottle through the glass tube which has one end submerged under water to form a seal. This provides a one-way valve that prevents a backflow of air into the pleural cavity, which could collapse the lung. As fluid and air from the pleural cavity enter the drainage bottle, the air that is displaced in the bottle is vented through the short tube above water level. B, The second bottle in the two-bottle system acts as a trap to control and decrease the amount of suction within the chest tube. Otherwise, the suction might be too forceful and damage the pleural membrane. No drainage enters this bottle. Its only purpose is to control the force of suction applied. C, The third bottle in the three-bottle system also is used to regulate the amount of suction. This can be done by adjusting the length of the glass tube that is under water.
 Pleur-evac Adult/Pediatric Chest Drainage Model A-6000. The Pleur-evac Chest Drainage Systems have been the world's most popular units since their inception in 1967. (Courtesy of Deknatel, Inc., Fall River, MA.)

chest

(chest),
1. The part of the body between the neck and the abdomen, enclosed by the ribs and the sternum.
See also: thorax.
2. Colloquially, the anterior wall of the thorax. Synonym(s): pectus
[A.S. cest, a box]

chest

(chest) thorax.
flail chest  one whose wall moves paradoxically with respiration, owing to multiple fractures of the ribs.
funnel chest  pectus excavatum.
pigeon chest  pectus carinatum.

chest

(chĕst)
n.
The part of the body between the neck and the abdomen, enclosed by the ribs and the breastbone; the thorax.

chest

Etymology: AS, box
1 See thorax.
2 the outside front part of the basic thoracic structure. See also thoracic cage, thoracic cavity.
enlarge picture
Lateral chest landmarks

thorax

The region between the neck and abdomen, which contains the heart, lungs (and the various veins, arteries, valves and tubules needed for their maintenance and functionality), thymus and oesophagus.

chest

Thorax A popular term for the region between the neck and abdomen, which contains the heart and lungs plumbing and wiring. See Barrel chest, Dirty chest of Simon, Flail chest.

chest

(chest)
The anterior wall of the thorax.
See also: thorax
Synonym(s): pectus [TA] .
[A.S. cest, a box]

chest

see thorax, thoracic, flail chest.

chest compression
a means of external cardiac massage; most likely to be effective in small dogs and cats, but very difficult in large animals.
chest wound
common in horses and cattle, damage to the underlying chest wall with communication to the pleural cavity and pneumothorax is the main danger.

Patient discussion about chest

Q. I was in the ER because of a chest pain and the doctor there said its costochondritis. What does it mean? I am a 42 years old man. Last night i went to the ER because of a chest pain. The doctors there did many test and in the end they said its costochondritis. What does it mean? Can someone elaborate about the risk factors that can cause this symptom?

A. It seems that you are suffering from a traumatic injury to the skeleton that is near the heart which is called costochondritis. It can be a result of a simple trauma to the area or (as in my case, I am a rower) due to repetitive use of the muscles of the thorax and arms

Q. I still have chest pain after 5 angioplasties/stents. Does anybody else still have that much angina?

A. my uncle had the same problem. went through several catheterization at several different cardiologist (some are well known), but couldn't get this annoying pain off his chest. the weird part was that it didn't even reacted to effort. but eventually (i don't remember the stent amount) one of the cardiologist solved the problem. so don't give up and continue searching the cause!

Q. What is the differential diagnosis of chest pain in a 35 year old woman? I am a 35 years old woman. I suffer from chest pain for about 24 hours. I just came back from a trip to Europe, and i feel really bad. I smoke and I take anti contraceptive and i know that I am at a risk for pulmonary embolism or costochondritis. Cat it be something else?

A. The differential diagnosis of chest pain is very wide.
It can start in costochondritis if u carried a lot of luggage or might be pulmonary embolism if you didn't move from the chair all the flight. But it can also be a sign for an acute coronary syndrome (even at the age of 35) or a pericarditis. To be sure you need to consult with your GP.

More discussions about chest
References in classic literature ?
Your daughter is frozen quite stiff and cold, And shall never have a chest full of gold.
The chest was securely fastened, and the Captain wrote an address on the lid, in characters which must have belonged to Modern Greece.
Porthos began to hope that the thing would take place at the present sitting, and in that same locality; but the procurator would listen to nothing, he would be taken to his room, and was not satisfied till he was close to his chest, upon the edge of which, for still greater precaution, he placed his feet.
For a while, he doubted whether there were any hidden chest of gold, and, in that case, whether he was so exceedingly wise to tear the house down, only to be convinced of its non-existence.
The veteran hoisted one end of the lumbering sea chest on the gunwale of the boat, and seized the handle at the other end to lift it in, when the motion propelled the boat from the shore, the chest slipped off from the gunwale, and, sinking into the waves, pulled the veteran headlong after it.
Having obtained a light, he discovered this to be a glass wheel, part of an elaborate piece of mechanism which he must in his sleep have taken from the chest, which was now opened.
Her resolute effort threw back the lid, and gave to her astonished eyes the view of a white cotton counterpane, properly folded, reposing at one end of the chest in undisputed possession!
So I told his lie with unction at my bank, and made due arrangements for the reception of his chest next morning.
When our eyes grew used to it we saw that the chest was three-parts full of uncut diamonds, most of them of considerable size.
A portion of his chest was laid bare to the ribs, three of which had been broken by the mighty blows of the gorilla.
Sonya, shaking off some down which clung to her and tucking away the verses in the bosom of her dress close to her bony little chest, ran after Natasha down the passage into the sitting room with flushed face and light, joyous steps.
Several metal-bound, copper-studded chests constituted the sole furniture of the round room.