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Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Analgesia, pulmonary toilet, aggressive chest physiotherapy, incentive spirometry and ambulation are generally all that is necessary to treat rib fractures. Both mortality and morbidity increase with age and number of fractured ribs. An epidural catheter is an excellent method to achieve adequate analgesia and lower morality. The treatment is the same for a flail chest, with mechanical ventilation reserved for those in respiratory distress or showing signs of increasing exhaustion and declining respiratory function. The underlying pulmonary contusion generally contributes more to the respiratory compromise than does altered chest wall mechanics. Severe flail segments, markedly displaced rib fractures and rib fractures hindering ventilator weaning are among the potential indications for rib plating.
Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
As is the case with rib fracture, treatment of flail chest is aimed at management of respiratory depression. Non-invasive management includes analgesia, physiotherapy, supplemental oxygen, and continuous positive end-expiratory pressure. Operative intervention for flail chest is not common, but it may be indicated in instances of severe chest wall deformity and failure to wean mechanical ventilation.
Death Along the Tracks: The Role of Forensic Anthropology and Social Media in a Homicide Investigation
Published in Heather M. Garvin, Natalie R. Langley, Case Studies in Forensic Anthropology, 2019
Seven perimortem rib fractures were identified on four ribs from the left thorax. Two incomplete transverse fractures were identified on the shafts of left ribs 8–10 (see Figure 1.5). In addition, left rib 11 showed evidence of a single incomplete transverse shaft fracture. These fractures all show evidence of failure under tension on their internal surfaces, consistent with blunt force directed at the left side of the thorax. When these ribs are articulated, the fractures align between consecutive ribs. These fractures may have resulted from a single traumatic impact distributed over a broad area of the left thorax or may have resulted from multiple impacts. Rib fractures can result from accidents, falls, and direct blows to the thorax, with transverse fractures commonly resulting from direct blows to the chest (Galloway, 1999). When considered together, the fractures of the sternum and left thorax may be consistent with a “flail chest,” where multiple ribs are fractured in two or more places, resulting in movement of the flail (i.e., fractured) section in the opposite direction than the remaining chest wall during respiration. Flail chest is a serious medical condition often associated with bruising of the lungs, cardiac injuries, labored breathing (Knight, 1991), and also puncture of the parietal pleura, which can result in pneumothorax (Ciraulo et al., 1994). These injuries commonly result from a direct blow to the chest, including cases where an individual is kicked and stomped, and in motor vehicle accidents (Galloway, 1999).
Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study
Published in Expert Review of Respiratory Medicine, 2022
Hela Attia, Helmi Ben Saad, Karim Masmoudi, Imen Bannour, Mouna Ouaz, Kais Gardabbou, Ali Majdoub
A VAS score > 7 was a predictor of the nebulized MOR failure. This can be explained by the notion of the mechanism of violence leading to higher VAS in the MOR (-) group. In the latter group, the mean VAS score was 8 with 45% of the patients having VAS at 10. Multiple rib fractures and flail chest are generally associated with high-energy trauma, such as road traffic accidents [28]. Moreover, an increased number of rib fractures is associated with an increase in morbidity [29,30], and correlations between the number of ribs fractured, and injury severity score [29], and mortality [30] were reported. The treatment and follow-up of multiple rib fractures are critical due to their high incidence and their related serious complications [28]. According to the literature, the choice of the analgesic protocol depends on the degree and the intensity of pain [31]. Indeed, a more advanced evaluation of pain intensity should be performed at rest, and during cough and movement.
Challenges experienced during rehabilitation after traumatic multiple rib fractures: a qualitative study
Published in Disability and Rehabilitation, 2018
Jacqueline Claydon, Gregory Maniatopoulos, Lisa Robinson, Paul Fearon
Traditionally, multiple rib fractures were managed conservatively; often requiring prolonged mechanical ventilation [10]. The merits of various ventilator modes, including bi-level positive pressure, continuous positive airway pressure, intermittent positive pressure ventilation, or modes for mucociliary clearance to maintain respiratory health (including chest physiotherapy, continuous lateral rotational therapy, and high frequency chest wall oscillation therapy) are discussed in literature but not been evaluated by clinical trials [11]. A focus on reducing mortality has driven advancements in surgical techniques for fixation of rib fractures. Increasing numbers of people with multiple rib fractures undergo surgical fixation of their ribs. Research comparing clinical effectiveness of conservative versus surgical techniques indicates surgical fixation has benefits. A systematic review and meta-analysis of the management of flail chest injuries included nine studies involving 538 patients compared surgical and conservative strategies and concluded that surgical fixation of flail chest is associated with a reduction in days of mechanical ventilation, hospital length of stay, mortality, and cost [12]. Figures from the United States indicate surgical fixation can reduce hospital costs by $10,000 [13] to $14,000 [14]. Similar benefits were identified through meta-analysis of studies comparing management of isolated multiple non-flail and painful rib fractures [15].
Primary repair of a completely ruptured intermediate bronchus after blunt chest trauma. Case report
Published in Acta Chirurgica Belgica, 2022
Cross-sectional imaging with computed tomography (CT) was then performed, unveiling multiple thoracic injuries (Figures 1(A) and 2(A)). Firstly, a bilateral pneumothorax, right larger than left, with left mediastinal shift. Secondly, extensive pulmonary contusions in both lower lobes and the right upper lobe. Lastly, suspicion of bilateral flail chest, with multiple contiguous rib fractures existing from rib 4–7 left and 7–9 right and a penetrating bone fragment posteriorly at rib 5 left (Figrue 2(B)).