Flail Chest: Difference between revisions

(Created page with "{{subst:Condition}} Flail segment is a portion of the rib cage that breaks due to trauma and becomes unattached from the chest wall. (Pettiford, Luketich & Landreneau, 2007)....")
 
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'''Original Editor '''- Your name will be added here if you created the original content for this page.
'''Jennifer Lohmus '''  
 
'''Lead Editors'''  &nbsp; 
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</div>  
== Clinically Relevant Anatomy<br>  ==
== Clinically Relevant Anatomy<br>  ==
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add text here relating to '''''clinically relevant''''' anatomy of the condition<br>  
add text here relating to '''''clinically relevant''''' anatomy of the condition<br>  


== Mechanism of Injury / Pathological Process<br> ==
== Pathophysiology ==
“A break in the structural continuity of the bone” that can be caused by trauma, stress and pathological factors. (Apley, Solomon, Warwick, Nayagam & Apley, 2005)
 
Types:
* Complete
* Incomplete
* Physeal
Classification according to the nature of the fracture:
* Spiral
* Transverse
* Comminuted
* Compression


add text here relating to the mechanism of injury and/or pathology of the condition<br>
==  Associated conditions:  ==
Pulmonary complications 48-72 hours after admission (Battle, Hutchings, James, & Evans, 2013):
* haemothorax
* pneumothorax
* atelectasis
* pneumonia
* pleural effusion
* subcutaneous emphysema
* ARDS,
* pulmonary emboli
* aspiration
* lobar collapse
Risk factors for developing associated conditions (Battle, Hutchings, James, & Evans, 2013):
* >65 years old
* >3 rib fractures
* Hx. of chronic lung conditions or CVD
* Pre-injury anti-coagulant use
* <90% SpO2


== Clinical Presentation  ==
== Clinical Presentation  ==


add text here relating to the clinical presentation of the condition<br>  
Flail segment is a portion of the rib cage that breaks due to trauma and becomes unattached from the chest wall. (Pettiford, Luketich & Landreneau, 2007).<br>  


== Diagnostic Procedures  ==
== Diagnostic Procedures  ==
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== Outcome Measures  ==
== Outcome Measures  ==


add links to outcome measures here (see [[Outcome Measures|Outcome Measures Database]])  
[https://pulmonaryrehab.com.au/~resources/02_Patient_assessment/04_modified_borg_dyspnoea_scale.pdf Modified BORG Scale]
 
[https://www.physio-pedia.com/Visual_Analogue_Scale VAS Scale for Pain]  
 
== Physiotherapy Management / Interventions  ==
 
Chest physiotherapy management consists of the following (May, Hillermann & Patil, 2016):


== Management / Interventions<br>  ==
1. Ventilatory Management - supplemental oxygen therapy, continuous positive airway pressure or intubation if necessary
* CPAP - for negative intrapleural pressure and paradoxical movement,  increases TV (May, Hillermann & Patil, 2015)
* Open/closed suction if patient intubated (Berney, Haines & Denehy, 2012)
2. Pain Management and Education
* Education on fracture healing
3. Early mobilization if possible
* Transfers to sitting out of bed
* Mobilization 2-3x daily and SOOB 3-4x/day
4. Chest and airway clearance techniques (if inadequate)
* ACT: nebulizer with ACBT and education
* Bubble PEP or Flutter
5. Deep breathing exercises and supported coughing technique
* Supported Cough: Wrap around technique or rolled up towel
* DBE/TEE’s with SMIs (2-4 secs hold)
6. Positioning
* Positioning in side lying and high sitting (Berney, Haines & Denehy, 2012)


add text here relating to management approaches to the condition<br>
== Medical Management ==
Medications: (May, Hillermann & Patil, 2016)
# Simple Analgesics
# Opioids
# Patient Controlled Analgesia
# Operative fixation and Regional Anaesthetic


== Differential Diagnosis<br>  ==
Surgery:


add text here relating to the differential diagnosis of this condition<br>
Conservative (May, Hillermann & Patil, 2016)
* Regional anaesthesia
* Serratus anterior block
* Paravertebral block
* Thoracic epidural


== Resources <br>  ==
== Differential Diagnosis ==


add appropriate resources here  
add text here relating to the differential diagnosis of this condition<br>


== References  ==
== Resources  ==
http://cochranelibrary-wiley.com/store/10.1002/14651858.CD009919.pub2/asset/CD009919.pdf?v=1&t=jifoudyr&s=e7896e4d8456ad584d26733382cd346002f2a11e


<references />
https://www.rch.org.au/trauma-service/manual/chest-injury/


Flail segment is a portion of the rib cage that breaks due to trauma and becomes unattached from the chest wall. (Pettiford, Luketich & Landreneau, 2007).
https://www.wcpt.org/wcpt2017/FS-01


  Chest physiotherapy management consists of the following (May, Hillermann & Patil, 2016):
== References ==


1. Ventilatory Management - supplemental oxygen therapy, continuous positive airway pressure or intubation if necessary
Battle C, Hutchings H, Evans PA. Blunt chest wall trauma: A review. Trauma. 2013;15(2):156-75.
2. Pain Management and Education
3. Early mobilization if possible
4. Chest and airway clearance techniques (if inadequate)  
4. Deep breathing exercises and supported coughing technique


References
Jena R, Agrawal A, Sandeep Y, Shrikhande N. Understanding of flail chest injuries and concepts in management. International Journal of Studentsí Research. 2016;6(1):3-5.


May L, Hillermann C, Patil S. Rib fracture management. BJA Education. 2016;16(1):26-32.
May L, Hillermann C, Patil S. Rib fracture management. BJA Education. 2016;16(1):26-32.


Pettiford BL, Luketich JD, Landreneau RJ. The Management of Flail Chest. Thoracic Surgery Clinics. 2007;17(1):25-33.
Pettiford BL, Luketich JD, Landreneau RJ. The Management of Flail Chest. Thoracic Surgery Clinics. 2007;17(1):25-33.
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.

Revision as of 11:02, 15 June 2018

Jennifer Lohmus

Clinically Relevant Anatomy
[edit | edit source]

add text here relating to clinically relevant anatomy of the condition

Pathophysiology[edit | edit source]

“A break in the structural continuity of the bone” that can be caused by trauma, stress and pathological factors. (Apley, Solomon, Warwick, Nayagam & Apley, 2005)

Types:

  • Complete
  • Incomplete
  • Physeal

Classification according to the nature of the fracture:

  • Spiral
  • Transverse
  • Comminuted
  • Compression

Associated conditions:[edit | edit source]

Pulmonary complications 48-72 hours after admission (Battle, Hutchings, James, & Evans, 2013):

  • haemothorax
  • pneumothorax
  • atelectasis
  • pneumonia
  • pleural effusion
  • subcutaneous emphysema
  • ARDS,
  • pulmonary emboli
  • aspiration
  • lobar collapse

Risk factors for developing associated conditions (Battle, Hutchings, James, & Evans, 2013):

  • >65 years old
  • >3 rib fractures
  • Hx. of chronic lung conditions or CVD
  • Pre-injury anti-coagulant use
  • <90% SpO2

Clinical Presentation[edit | edit source]

Flail segment is a portion of the rib cage that breaks due to trauma and becomes unattached from the chest wall. (Pettiford, Luketich & Landreneau, 2007).

Diagnostic Procedures[edit | edit source]

add text here relating to diagnostic tests for the condition

Outcome Measures[edit | edit source]

Modified BORG Scale

VAS Scale for Pain

Physiotherapy Management / Interventions[edit | edit source]

Chest physiotherapy management consists of the following (May, Hillermann & Patil, 2016):

1. Ventilatory Management - supplemental oxygen therapy, continuous positive airway pressure or intubation if necessary

  • CPAP - for negative intrapleural pressure and paradoxical movement,  increases TV (May, Hillermann & Patil, 2015)
  • Open/closed suction if patient intubated (Berney, Haines & Denehy, 2012)

2. Pain Management and Education

  • Education on fracture healing

3. Early mobilization if possible

  • Transfers to sitting out of bed
  • Mobilization 2-3x daily and SOOB 3-4x/day

4. Chest and airway clearance techniques (if inadequate)

  • ACT: nebulizer with ACBT and education
  • Bubble PEP or Flutter

5. Deep breathing exercises and supported coughing technique

  • Supported Cough: Wrap around technique or rolled up towel
  • DBE/TEE’s with SMIs (2-4 secs hold)

6. Positioning

  • Positioning in side lying and high sitting (Berney, Haines & Denehy, 2012)

Medical Management[edit | edit source]

Medications: (May, Hillermann & Patil, 2016)

  1. Simple Analgesics
  2. Opioids
  3. Patient Controlled Analgesia
  4. Operative fixation and Regional Anaesthetic

Surgery:

Conservative (May, Hillermann & Patil, 2016)

  • Regional anaesthesia
  • Serratus anterior block
  • Paravertebral block
  • Thoracic epidural

Differential Diagnosis[edit | edit source]

add text here relating to the differential diagnosis of this condition

Resources[edit | edit source]

http://cochranelibrary-wiley.com/store/10.1002/14651858.CD009919.pub2/asset/CD009919.pdf?v=1&t=jifoudyr&s=e7896e4d8456ad584d26733382cd346002f2a11e

https://www.rch.org.au/trauma-service/manual/chest-injury/

https://www.wcpt.org/wcpt2017/FS-01

References[edit | edit source]

Battle C, Hutchings H, Evans PA. Blunt chest wall trauma: A review. Trauma. 2013;15(2):156-75.

Jena R, Agrawal A, Sandeep Y, Shrikhande N. Understanding of flail chest injuries and concepts in management. International Journal of Studentsí Research. 2016;6(1):3-5.

May L, Hillermann C, Patil S. Rib fracture management. BJA Education. 2016;16(1):26-32.

Pettiford BL, Luketich JD, Landreneau RJ. The Management of Flail Chest. Thoracic Surgery Clinics. 2007;17(1):25-33.

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.

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