Flail chest: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Paradoxical inward movement of involved portion during inspiration | *Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 10:10, 28 January 2018
Background
- Due to segmental 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
- Commonly associated with respiratory failure (due to pulmonary contusion)
Evaluation
- Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration)
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Management
- Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation
- Analgesia
- Consider intubation even if patient's breathing initially seems adequate, especially if:
- Shock
- Severe head injury
- Comorbid pulmonary disease
- Fracture of 8 or more ribs
- Age >65
- Surgical fixation is controversial