Thyroid & Adrenal
Regarding flail chest all the following are true EXCEPT
|A||At least fracture of three ribs bilaterally|
|B||Should be intubated if Po2 less than 40% with 60 % oxygen|
|C||Paradoxical breathing is not seen in conscious pt|
|D||If widely overlapping rips is seen then it should be treated with surgery and open reduction (Fixation)|
a. Flail chest: paradoxical movement of a segment of chest wall caused by fracture of 3 or more risk anteriorly and posteriorly within each rib, variation include posterior flail segment, anterior flail segment and flail including the sternum with ribs on both sides of thoracic cage fractured. .
b. Presentation: It is a clinical anatomic diagnosis noted in blunt trauma patients with paradoxical or reverse motion of a chest wall segment with spontaneously breathing.
c. The strict definition of 3 ribs broken in 2 or more places can be confirmed by X-ray, but inherent structural stability of the chest wall due to ribs and intercostals muscles usually does not show abnormal or paradoxical motion without 3 or more ribs involved.
d. Treatment: Treatment of flail ranges from pain control and pulmonary toilet (including medical management of their pulmonary injury) to mechanical ventilation.
e. Patient controlled analgesia machines, oral pain medication and indwelling catheter form initial main stay of treatment IPPV reserved for patient with persistent respiratory insufficiency or patient not maintaining oxygen saturation.