Flail chest: Difference between revisions
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*Commonly associated with respiratory failure (due to pulmonary contusion) | *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) | *Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration) | ||
==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.]] | |||
==Management== | ==Management== | ||
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**Age >65 | **Age >65 | ||
*Surgical fixation is controversial | *Surgical fixation is controversial | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
Revision as of 18:14, 13 June 2020
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)
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.
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
Disposition
- Admit