All are true about Flail chest, except
Correct Answer: Paradoxical movement may not be seen in conscious patients
Description: FAIL CHEST is when the position of a bony chest wall looses its continuity from the reminder of thorax.due to multiple fractures by definition flail chest occurs in presence of 2 or more fractures in 3 or more consecutive ribs ( either in one side of the chest wall or either side of the sternum) and causes instability of the chest wall ; however it can alsonoccur after costochondral separation flail chest is characterised by paradoxical motion of the chest wall ( inward with inspiration and outward with expiration ). chances of having an intrathorasic injury increasex several fold .The paradoxical motion increases the work of breathing and most impoant consequence is respiratory failure Until recently it was belived that ineffective air movement between both lungs caused by paradoxical motion of the chest wall was the cause of respiratory distress in patients with flail chest .It is now understood that the underlying pulmonary contusion and pain during inspiration are the main componentsin the pathophysiology of respiratory failure MANAGEMENT patients without evidence of respiratory distress can be managed with only analgesics. pain control can be provided by intercostal nerve block or more adequately by epidural anaesthesia if respiratory distress develops - endotracheal intubation and mechanical ventilation with peak end expiratory pressure are usually indicated, provided that pain control is adequate sequential aerial blood gas determination may gauge the severity of injury and is useful to determine the need for mechanical ventilation . The ratio of aerial oxygen tension to the fraction of inspired oxygen (pao2;fio2)yealds an estimate of extent of intra pulmonary shunts and useful parameter for need for mechanical ventilation intubation is delayed until clear evidence of a need for ventilatory suppo develops - respiratory rate of 40/min , a fallins paco2 or a pao2 below 60torr on inspired o2 fraction of over 0.5 open reduction plus internal fixation of sternal or rib fractures is rarely required .
Category:
Surgery
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