Flail chest: Difference between revisions

Revision as of 04:15, 24 September 2019

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)

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

@@ Line 1: / Line 1: @@
 ==Background==
-*Free-floating segment of ribs that is no longer attached to rest of thorax
+*Due to segmental [[rib fractures]] (in 2 or more locations on same rib) of 3 or more adjacent ribs
-*Commonly associated w/ respiratory failure
+**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==
+==Evaluation==
+*Paradoxical movement of affected segment (inward movement of involved portion during inspiration, outward during expiration)
+==Differential Diagnosis==
+{{Thoracic trauma DDX}}
-==Treatment==
+==Management==
-*Consider intubation even if pt's breathing initially seems adequate
+*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==
@@ Line 15: / Line 27: @@
 *[[Tension Pneumothorax]]
-[[Category:Pulm]]
+[[Category:Pulmonary]]
 [[Category:Trauma]]