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 | ||
*Commonly associated | **Leads to free-floating segment of ribs that no longer attach to rest of thorax | ||
*Commonly associated with respiratory failure (due to pulmonary contusion) | |||
== | ==Evaluation== | ||
*Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration) | |||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
== | ==Management== | ||
*Consider intubation even if | *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 | |||
==See Also== | ==See Also== | ||
[[Thoracic Trauma]] | *[[Thoracic Trauma]] | ||
*[[Traumatic Pneumothorax]] | |||
*[[Spontaneous Pneumothorax]] | |||
*[[Tension Pneumothorax]] | |||
[[Category:Pulmonary]] | |||
[[Category:Trauma]] |
Revision as of 10:10, 28 January 2018
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)
Evaluation
- 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
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