Daily Bolus of LR: Flail Chest

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July 8, 2011 by dailybolusoflr

Flail Chest

·         Thought to be an uncommon injury, but found in patients with blunt chest trauma

·         Is defined as three or more adjacent ribs that are fractured at two points.  This allows the segment to move freely in the chest

·         Paradoxical Motion- is the hallmark of the condition.  It is characterized by inward movement of the fractured segment during inhalation (typically the chest expands) as well as outward movement during exhalation

·         Associated lung injury (typically pulmonary contusion) is the cause of most of the morbidity and mortality associated with this condition (up to 35%) and patients should be presumed to have pulmonary contusion if flail chest is found

·         Therapy is somewhat controversial in terms of definitive management in patients with respiratory compromise- but the most recent position paper from EAST encourages symptomatic therapy and less absolute recommendation of mechanical ventilation

o   Options now include use of NIMV, selective intubation when unilateral injury is present and true mechanical ventilation

o   A smaller group of patients also will need surgical fixation (those who cannot wean or have severe chest wall instability)

o   Restriction of fluid in patients with pulmonary contusion has also not been supported in the literature

·         Agreement exists over use of pain control, oxygen and pulmonary PT



Rosen’s 7th edition



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