Flail Chest and Pulmonary Contusion

Published on 07/03/2015 by admin

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Last modified 07/03/2015

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Chapter 68 Flail Chest and Pulmonary Contusion

4 What is a flail chest, and how is it diagnosed?

Flail chest is defined as fractures of three or more consecutive ribs or costal cartilages fractured in two or more places (Fig. 68-1). These fractured segments give rise to a free-floating portion of the thorax, which moves paradoxically throughout the respiratory cycle, with inward motion with inspiration and outward motion with exhalation. Although rib fractures may be diagnosed radiographically, flail chest is a clinical diagnosis. Patients often present with chest wall pain, tenderness, bruising, and palpable step-offs of the ribs, but flail chest is distinguished from other chest trauma by noting the paradoxical movement of the chest wall during spontaneous respiration. Patients receiving positive pressure ventilation usually do not demonstrate the classic paradoxical movements. Respiratory dysfunction usually does not arise from the paradoxical chest motion but rather is due to underlying contusions and splinting from pain.

10 What are the basic treatment strategies for flail chest or pulmonary contusions?

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