Treatment of choice in severe flail chest is
|C||Fixation of fractured ribs with wire|
|D||IPPV (Intermittent positive pressure ventilation)|
a. Flail chest is the most serious of the blunt chest wall injuries.
b. It involves fractures of adjacent ribs, each of which is fractured in two or more places, so that a panel of chest wall moves independently of, and in the opposite direction to, the remainder of the chest.
c. When it occurs in conjunction with separation of the costochondral or costosternal joints, the sternum can also be part of the flail segment, and the condition is termed a sternal flail chest.
d. The diagnosis is typically suspected on the basis of the presence of numerous adjacent rib fractures on a chest radiograph, but it can be conclusively confirmed only by the presence of a paradoxical motion observed in the involved segment in a spontaneously breathing patient.
e. Pulmonary contusion is the most commonly associated injury.
f. Maintenance of adequate ventilation is the goal of therapy.
g. Mechanical ventilation with positive-pressure ventilation is used to treat injuries in the elderly or in those patients with underlying pulmonary disease.