Flail chest: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Paradoxical movement of affected segment | *Paradoxical movement of affected segment | ||
**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== | ||
| Line 18: | Line 20: | ||
==Management== | ==Management== | ||
*[[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]] | ||
Latest revision as of 20:31, 10 February 2021
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)
Clinical Features
- Paradoxical movement of affected segment
- Inward movement of involved portion during inspiration, outward during expiration
- Often have concomitant pulmonary contusion[1]
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
Chest x-ray off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.
- Possibly a clinical diagnosis
- Consider CXR or chest CT
Management
- 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:
- Shock
- Severe head injury
- Comorbid pulmonary disease
- Fracture of 8 or more ribs
- Age >65
- Surgical fixation is controversial
Disposition
- Admit
See Also
- Thoracic Trauma
- Traumatic Pneumothorax
- Spontaneous Pneumothorax
- Tension Pneumothorax
- Fractures (main)
External Links
References
- ↑ Davignon K, Kwo J, Bigatello LM. Pathophysiology and management of the flail chest. Minerva Anestesiol. 2004;70(4):193-199.