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) | ||
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*Paradoxical inward movement of involved portion during inspiration | *Paradoxical inward movement of involved portion during inspiration | ||
Revision as of 01:33, 22 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)
Evaluation
- Paradoxical inward movement of involved portion during inspiration
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