Flail chest: Difference between revisions
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*Due to segmental fractures (in 2 or more locations on same rib) of 3 or more adjacent ribs | *Due to segmental 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 | *Commonly associated with respiratory failure (due to pulmonary contusion) | ||
==Diagnosis== | ==Diagnosis== | ||
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==Management== | ==Management== | ||
*Pts | *Pts with mild-moderate flail chest who are otherwise healthy may be managed with out PPV | ||
*Analgesia | *Analgesia | ||
*Consider intubation even if patient's breathing initially seems adequate, esp if: | *Consider intubation even if patient's breathing initially seems adequate, esp if: | ||
Revision as of 19:57, 11 July 2016
Background
- Due to segmental 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)
Diagnosis
- Paradoxical inward movement of involved portion during inspiration
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Management
- Pts with mild-moderate flail chest who are otherwise healthy may be managed with out PPV
- Analgesia
- Consider intubation even if patient's breathing initially seems adequate, esp if:
- Shock
- Severe head injury
- Comorbid pulmonary disease
- Fracture of 8 or more ribs
- Age >65
- Surgical fixation is controversial