Flail chest: Difference between revisions

Revision as of 18:37, 13 June 2020

Diagrams depicting the paradoxical motion observed during respiration with a flail segment.

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
Commonly associated with respiratory failure (due to pulmonary contusion)

Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration)

Chest x-ray off a flail chest associated with right sided pulmonary contusion and subcutaneous emphysema.

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

Authors:

@@ Line 18: / Line 18: @@
 ==Management==
-*Otherwise healthy patients with mild-moderate flail chest may be managed without positive pressure ventilation
 *[[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]]