Flail chest: Difference between revisions
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==Background== | ==Background== | ||
*Due to segmental 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 | ||
*Commonly associated with respiratory failure (due to pulmonary contusion) | *Commonly associated with respiratory failure (due to pulmonary contusion) | ||
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==Management== | ==Management== | ||
*Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation | *Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation | ||
*Analgesia | *[[Analgesia]] | ||
*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]] | ||
**Severe head injury | **Severe [[head injury]] | ||
**Comorbid pulmonary disease | **Comorbid pulmonary disease | ||
**Fracture of 8 or more ribs | **Fracture of 8 or more ribs | ||
Revision as of 04:15, 24 September 2019
Background
- 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
- 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