Flail chest - Revision history

Elcatracho: /* Clinical Features */

2021-02-10T20:31:17Z

Clinical Features

← Older revision		Revision as of 20:31, 10 February 2021
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	*Paradoxical movement of affected segment		*Paradoxical movement of affected segment
	**Inward movement of involved portion during inspiration, outward during expiration		**Inward movement of involved portion during inspiration, outward during expiration
			*Often have concomitant [[pulmonary contusion]]<ref>Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004;70(4):193-199.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

2020-06-13T18:41:03Z

Clinical Features

← Older revision		Revision as of 18:41, 13 June 2020
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	==Clinical Features==		==Clinical Features==
	*Paradoxical movement of affected segment ~~(inward~~ movement of involved portion during inspiration, outward during expiration)		*Paradoxical movement of affected segment
			**Inward movement of involved portion during inspiration, outward during expiration

	==Differential Diagnosis==		==Differential Diagnosis==

2020-06-13T18:37:44Z

Management

← Older revision		Revision as of 18:37, 13 June 2020
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	==Management==		==Management==
	*Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation
	*[[Analgesia]]		*[[Analgesia]]
			*Consider positive pressure ventilation
			**Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation
	*Consider [[intubation]] even if patient's breathing initially seems adequate, especially if:		*Consider [[intubation]] even if patient's breathing initially seems adequate, especially if:
	**[[Shock]]		**[[Shock]]

2020-06-13T18:27:42Z

Evaluation

← Older revision		Revision as of 18:27, 13 June 2020
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	==Evaluation==		==Evaluation==
	[[File:Pulmonary contusion.jpg\|thumb\|[[Chest x-ray]] off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.]]		[[File:Pulmonary contusion.jpg\|thumb\|[[Chest x-ray]] off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.]]
	*[[CXR]] or CT		*Possibly a clinical diagnosis
			*Consider [[CXR]] or chest CT

	==Management==		==Management==

2020-06-13T18:27:06Z

Evaluation

← Older revision		Revision as of 18:27, 13 June 2020
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	==Evaluation==		==Evaluation==
	[[File:Pulmonary contusion.jpg\|thumb\|[[Chest x-ray]] off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.]]		[[File:Pulmonary contusion.jpg\|thumb\|[[Chest x-ray]] off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.]]
			*[[CXR]] or CT

	==Management==		==Management==

2020-06-13T18:24:23Z

Background

← Older revision		Revision as of 18:24, 13 June 2020
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	==Background==		==Background==
			[[File:Flail chest mechaincs.jpg\|thumb\|Diagrams depicting the paradoxical motion observed during respiration with a flail segment.]]
	[[File:Flailchest3to9.png\|thumb\|3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.]]		[[File:Flailchest3to9.png\|thumb\|3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.]]
	~~[[File:Flail chest mechaincs.jpg\|thumb\|Diagrams depicting the paradoxical motion observed during respiration with a flail segment.]]~~
	*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs		*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs
	**Leads to free-floating segment of ribs that no longer attach to rest of thorax		**Leads to free-floating segment of ribs that no longer attach to rest of thorax

2020-06-13T18:21:17Z

Background

← Older revision		Revision as of 18:21, 13 June 2020
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	==Background==		==Background==
	[[File:Flailchest3to9.png\|thumb\|3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.]]		[[File:Flailchest3to9.png\|thumb\|3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.]]
			[[File:Flail chest mechaincs.jpg\|thumb\|Diagrams depicting the paradoxical motion observed during respiration with a flail segment.]]
	*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs		*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs
	**Leads to free-floating segment of ribs that no longer attach to rest of thorax		**Leads to free-floating segment of ribs that no longer attach to rest of thorax

2020-06-13T18:15:35Z

2020-06-13T18:14:38Z

← Older revision		Revision as of 18:14, 13 June 2020
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	*Commonly associated with respiratory failure (due to pulmonary contusion)		*Commonly associated with respiratory failure (due to pulmonary contusion)

	==~~Evaluation~~==		==Clinical Features==
	*Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration)		*Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration)

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Thoracic trauma DDX}}		{{Thoracic trauma DDX}}

			==Evaluation==
			[[File:Pulmonary contusion.jpg\|thumb\|[[Chest x-ray]] off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.]]

	==Management==		==Management==
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	**Age >65		**Age >65
	*Surgical fixation is controversial		*Surgical fixation is controversial

			==Disposition==
			*Admit

	==See Also==		==See Also==

2020-06-13T18:03:14Z

Background

← Older revision		Revision as of 18:03, 13 June 2020
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	==Background==		==Background==
			[[File:Flailchest3to9.png\|thumb\|3D reconstruction from a CT scan showing a flail chest. Arrows mark the rib fractures.]]
	*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs		*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs
	**Leads to free-floating segment of ribs that no longer attach to rest of thorax		**Leads to free-floating segment of ribs that no longer attach to rest of thorax