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 | [[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.]] | |||
*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) | ||
== | ==Clinical Features== | ||
*Paradoxical | *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== | ||
{{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.]] | |||
*Possibly a clinical diagnosis | |||
*Consider [[CXR]] or chest CT | |||
==Management== | ==Management== | ||
* | *[[Analgesia]] | ||
*Consider positive pressure ventilation | |||
*Consider intubation even if patient's breathing initially seems adequate, | **Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation | ||
**Shock | *Consider [[intubation]] even if patient's breathing initially seems adequate, especially if: | ||
**Severe head injury | **[[Shock]] | ||
**Severe [[head injury]] | |||
**Comorbid pulmonary disease | **Comorbid pulmonary disease | ||
**Fracture of 8 or more ribs | **Fracture of 8 or more ribs | ||
**Age >65 | **Age >65 | ||
*Surgical fixation is controversial | *Surgical fixation is controversial | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
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*[[Spontaneous Pneumothorax]] | *[[Spontaneous Pneumothorax]] | ||
*[[Tension Pneumothorax]] | *[[Tension Pneumothorax]] | ||
*[[Fractures (main)]] | |||
==External Links== | |||
==References== | |||
<references/> | |||
[[Category:Pulmonary]] | [[Category:Pulmonary]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
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.