Introduction[edit | edit source] Show
A flail chest describes when a segment of the rib cage breaks due to blunt thoracic trauma, high speed motor vehicle crash and becomes unattached from the chest wall.[1]It can occur when 3 or more ribs are broken in at least two places, although not everyone with type of injury will develop a flail chest. However, if these injuries cause a segment of the chest to move independently, the generation of negative intrapleural pressure indicates a true paradoxical flail segment[2]. This condition is of clinical significance in elderly patients or patients who have chronic lung disease, associated with morbidity and mortality. Pathophysiology[edit | edit source]This pathology of rib fracture associated with decrease chest movement due to pain that reduces the tidal volume and may predispose to significant atelectasis, impaired gas exchange in the affected lung beneath the fractured rib, altered in breathing mechanism. All these contributing factors may predispose later to pneumonia and pulmonary secretions retention, paradoxical chest movement.[2] [3] Types[edit | edit source]
Classification according to the nature of the fracture:
Associated Conditions[edit | edit source]Pulmonary complications 48-72 hours after admission[4]:
Risk factors for developing associated conditions[4]:
Clinical Presentation[edit | edit source]The clinical presentation depends on the severity of the impact, size of the flail segment and to what extent lung affected.[5]The patient may complain of severe chest wall pain and may have tachypnea. On close observation there may be paradoxical chest wall movement. On inspiration the flail segment will move inwards whilst the rest of the chest expands and on expiration the flail segment will move outwards whilst the rest of the chest contracts. If the patient is mechanically ventilated or on Bilevel Positive Airway Pressure (BiPAP) it may be difficult to diagnose and may only become obvious after extubation. Diagnostic Procedures[edit | edit source]An abnormal chest movement during breathing may be a sign of flail chest. Radiologists use Chest X-Rays to look for the following: “Three or more adjacent ribs are fractured in two or more places. Clinically this can be a segment of only one or two ribs can act as a flail segment” Outcome Measures[edit | edit source]Modified BORG Scale VAS Scale for Pain Medical Management[edit | edit source]Medications[edit | edit source]
Surgery[edit | edit source]
Internal Fixation[edit | edit source]
Physiotherapy Management[edit | edit source]Role of chest physiotherapy for inpatient care depend on secretion clearance to prevent respiratory infection, restore normal lung volume, pulmonary function. There's still little information about physical therapy role after discharge from the hospital. Management consists of the following:
It was recommended to apply chest physiotherapy after adequate pain relief modalities[5] Resources[edit | edit source]cochranelibrary wiley.com www.rch.org.au/trauma service/manual/chest-injury www.wcpt.org radiopaedia.org articles, flail-chest References[edit | edit source]
7. Solomon L. Apley's concise system of orthopaedics and fractures. 3rd ed.. ed. Warwick D, Nayagam S, Apley AG, editors. London : New York: London : Hodder Arnold New York : Distributed in the United States by Oxford University Press; 2005. Which of the following is the most effective method of assessing the quality of air movement into the lungs?The most accurate way is called body plethysmography. You sit in a clear airtight box that looks like a phone booth. The technologist asks you to breathe in and out of a mouthpiece. Changes in pressure inside the box help determine the lung volume.
Which of the following is the most effective method of assessing the quality of air movement in the lungs quizlet?Which of the following is the most effective method of assessing the quality of air movement in the lungs? Auscultating breath sounds with a stethoscope.
Which of the following signs of respiratory distress is most commonly in pediatric patients?(See Tables 1 and 2.) Most commonly, tachypnea is the first sign of respiratory distress.
Which of the following abnormal breath sounds indicates obstruction of the upper airway?Less musical sounding than a wheeze, stridor is a high-pitched, turbulent sound that can happen when a child inhales or exhales. Stridor usually indicates an obstruction or narrowing in the upper airway, outside of the chest cavity.
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