Flail Chest
Rib Fractures
Sternum
Thoracic Surgical Procedures
Wounds, Nonpenetrating
Chordae Tendineae
Pathophysiology and management of the flail chest. (1/15)
Flail chest occurs when a series of adjacent ribs are fractured in at least 2 places, anteriorly and posteriorly. This section of the chest wall becomes unstable and it moves inwards during spontaneous inspiration. The physiological impact of a flail chest depends on multiple factors, including the size of the flail segment, the intrathoracic pressure generated during spontaneous ventilation, and the associated damage to the lung and chest wall. Treatment varies with the severity of the physiologic impairment attributable to the flail segment itself. Immediate surgical fixation may decrease morbidity, but conservative treatment with positive pressure ventilation is preferred when multiple injuries to the intrathoracic organs are present. (+info)A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest. (2/15)
INTRODUCTION: The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation. METHOD: The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group (n = 27) received mechanical ventilation with ETI, whereas patients in the CPAP group (n = 25) received CPAP via a face mask with patient controlled analgesia (PCA). Major complications, arterial blood gas levels, length of intensive care unit (ICU) stay and ICU survival rate were recorded. RESULTS: Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO(2) was significantly higher in the ET group in the first 2 days (p<0.05). There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received IPPV (p<0.01). CONCLUSION: Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma. (+info)Tension pneumothorax and the "forbidden CXR". (3/15)
A case is presented of unilateral tension pneumothorax associated with flail chest and pulmonary contusions in a spontaneously ventilating patient after a fall. The tension element was not suspected until chest x ray was available, nor was immediate needle thoracocentesis performed. No morbidity resulted as a consequence. This case highlights the difficulty in deciding whether or not tension pneumothorax is the predominant cause of respiratory distress in a patient with multiple chest injuries. It provides further evidence challenging some of the doctrine on how to treat suspected tension pneumothorax. (+info)An unusual cause of chest pain. (4/15)
Flail chest is an uncommon condition that generally arises due to a significant impact to the chest, resulting in multiple fractures of the anterior and posterior ribs. This force may be much less if the bones are weakened for any reason, in osteoporosis or myeloma for instance. We describe a case of flail segment that arose secondary to a large sternal abscess resulting from methicillin-resistant Staphylococcus aureus bacteraemia. (+info)Unilateral flail chest is seldom a lethal injury. (5/15)
BACKGROUND: The chest cage is a common target for traumatic damage. Although relatively rare, it is considered to be a serious condition with significant reported mortalities. As most flail injuries are accompanied by severe extrathoracic injuries, it is often difficult to pinpoint a single injury responsible for the patient's death. AIM: To investigate the factors related to mortality when flail injury is diagnosed. METHODS: Data from the Israel National Trauma Registry between 1998 and 2003 included 11,966 chest injuries (262 flail chest injuries) out of a total of 118,211 trauma hospitalisations. Mortality figures were analysed to determine which factors, singly or in combination, influenced flail chest mortality. RESULTS: Road crashes accounted for most flail injuries (76%). The total mortality was 54 (20.6%) of 262 patients with flail chest injuries. 13 (20.4%) of the deaths occurred soon after admission to the emergency room and 37 (68.5%) within the first 24 h. Mortality in moderate to severe injuries (injury severity score (ISS) 9-24) was 3.6% and that in critical injuries 28.5% (ISS >24). Mortality increased with age: 17% in those aged <45 years, 22.1% in those between 45 and 64 years and 28.8% in those >65 years. Age remained a risk for inpatient death when adjusted for severity. Mortality in isolated unilateral flail injury was not more than 6%. Total mortality for traumatic brain injury (TBI) and flail was 34%. Flail, TBI and other major injuries increased the mortality to 61.1%. CONCLUSIONS: Advanced age is associated with higher mortality. Isolated unilateral bony cage instability infrequently leads to death in patients who make it to the emergency department but rather its combination with additional extrathoracic trauma. (+info)Traumatic intercostal pulmonary herniation: a case report. (6/15)
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice. (+info)Operative stabilization of skeletal chest injuries secondary to cardiopulmonary resuscitation in a cardiac surgical patient. (7/15)
(+info)Treatment with internal pneumatic stabilization for anterior flail chest. (8/15)
OBJECTIVE: Advantages and disadvantages have been reported for both internal pneumatic stabilization and surgical stabilization as treatments for anterior flail chest. We retrospectively investigated therapeutic outcomes and problems associated with pneumatic stabilization for anterior flail chest patients. METHODS: Subjects were 43 patients admitted to Tokai University Hospital with anterior flail chest, 1988-1999. Pneumatic stabilization was performed with continuous positive pressure ventilation and a positive end-expiratory pressure of 10 cm H20 or higher. We analyzed mean times required for pneumatic stabilization, weaning, and mechanical ventilation; sternal fracture (presence vs. absence); survival, and other clinical variables. RESULTS: Continuous positive pressure ventilation was needed for 12.5 days and mechanical ventilation for 15.6 days. Flail chest was relieved by pneumatic stabilization alone in 42 patients; 1 patient with a displaced sternal fracture required sternal fixation. Four cases were complicated by pneumonia. Pneumatic stabilization allowed physicians to treat severe combined nonthoracic organ injuries during the acute phase. Forty patients survived, and 3 died from nonthoracic injuries (survival rate 93%). CONCLUSIONS: Anterior flail chest unaccompanied by sternal fracture can be relieved by pneumatic stabilization alone. We hope to combine pneumatic stabilization with simple surgical stabilization in anterior flail chest patients to shorten the mechanical ventilation period. (+info)Flail chest is a serious injury to the thorax characterized by a segment of the chest wall that moves paradoxically in relation to the rest of the chest wall during respiration. This occurs due to multiple rib fractures at two or more places, resulting in a free-floating section of the chest wall that is not connected to the sternum or spine.
During inspiration, when the chest normally expands, the flail segment moves inward, and during expiration, it moves outward, which can lead to significant impairment of ventilation and oxygenation. Flail chest can result from high-impact trauma such as motor vehicle accidents or falls, and it is often associated with underlying lung contusions or other injuries. It requires immediate medical attention and may necessitate mechanical ventilation and surgical stabilization of the rib cage to prevent complications such as pneumonia and respiratory failure.
Thoracic injuries refer to damages or traumas that occur in the thorax, which is the part of the body that contains the chest cavity. The thorax houses vital organs such as the heart, lungs, esophagus, trachea, and major blood vessels. Thoracic injuries can range from blunt trauma, caused by impacts or compressions, to penetrating trauma, resulting from stabbing or gunshot wounds. These injuries may cause various complications, including but not limited to:
1. Hemothorax - bleeding into the chest cavity
2. Pneumothorax - collapsed lung due to air accumulation in the chest cavity
3. Tension pneumothorax - a life-threatening condition where trapped air puts pressure on the heart and lungs, impairing their function
4. Cardiac tamponade - compression of the heart caused by blood or fluid accumulation in the pericardial sac
5. Rib fractures, which can lead to complications like punctured lungs or internal bleeding
6. Tracheobronchial injuries, causing air leaks and difficulty breathing
7. Great vessel injuries, potentially leading to massive hemorrhage and hemodynamic instability
Immediate medical attention is required for thoracic injuries, as they can quickly become life-threatening due to the vital organs involved. Treatment may include surgery, chest tubes, medications, or supportive care, depending on the severity and type of injury.
Rib fractures are breaks or cracks in the bones that make up the rib cage, which is the protective structure around the lungs and heart. Rib fractures can result from direct trauma to the chest, such as from a fall, motor vehicle accident, or physical assault. They can also occur from indirect forces, such as during coughing fits in people with weakened bones (osteoporosis).
Rib fractures are painful and can make breathing difficult, particularly when taking deep breaths or coughing. In some cases, rib fractures may lead to complications like punctured lungs (pneumothorax) or collapsed lungs (atelectasis), especially if multiple ribs are broken in several places.
It is essential to seek medical attention for suspected rib fractures, as proper diagnosis and management can help prevent further complications and promote healing. Treatment typically involves pain management, breathing exercises, and, in some cases, immobilization or surgery.
A contusion is a medical term for a bruise. It's a type of injury that occurs when blood vessels become damaged or broken as a result of trauma to the body. This trauma can be caused by a variety of things, such as a fall, a blow, or a hit. When the blood vessels are damaged, blood leaks into the surrounding tissues, causing the area to become discolored and swollen.
Contusions can occur anywhere on the body, but they are most common in areas that are more likely to be injured, such as the knees, elbows, and hands. In some cases, a contusion may be accompanied by other injuries, such as fractures or sprains.
Most contusions will heal on their own within a few days or weeks, depending on the severity of the injury. Treatment typically involves rest, ice, compression, and elevation (RICE) to help reduce swelling and pain. In some cases, over-the-counter pain medications may also be recommended to help manage discomfort.
If you suspect that you have a contusion, it's important to seek medical attention if the injury is severe or if you experience symptoms such as difficulty breathing, chest pain, or loss of consciousness. These could be signs of a more serious injury and require immediate medical attention.
A tracheotomy is a surgical procedure that involves creating an opening in the neck and through the front (anterior) wall of the trachea (windpipe). This is performed to provide a new airway for the patient, bypassing any obstruction or damage in the upper airways. A tube is then inserted into this opening to maintain it and allow breathing.
This procedure is often conducted in emergency situations when there is an upper airway obstruction that cannot be easily removed or in critically ill patients who require long-term ventilation support. Complications can include infection, bleeding, damage to surrounding structures, and difficulties with speaking, swallowing, or coughing.
Multiple trauma, also known as polytrauma, is a medical term used to describe severe injuries to the body that are sustained in more than one place or region. It often involves damage to multiple organ systems and can be caused by various incidents such as traffic accidents, falls from significant heights, high-energy collisions, or violent acts.
The injuries sustained in multiple trauma may include fractures, head injuries, internal bleeding, chest and abdominal injuries, and soft tissue injuries. These injuries can lead to a complex medical situation requiring immediate and ongoing care from a multidisciplinary team of healthcare professionals, including emergency physicians, trauma surgeons, critical care specialists, nurses, rehabilitation therapists, and mental health providers.
Multiple trauma is a serious condition that can result in long-term disability or even death if not treated promptly and effectively.
The sternum, also known as the breastbone, is a long, flat bone located in the central part of the chest. It serves as the attachment point for several muscles and tendons, including those involved in breathing. The sternum has three main parts: the manubrium at the top, the body in the middle, and the xiphoid process at the bottom. The upper seven pairs of ribs connect to the sternum via costal cartilages.
Thoracic surgical procedures refer to the operations that are performed on the thorax, which is the part of the body that lies between the neck and the abdomen and includes the chest cage, lungs, heart, great blood vessels, esophagus, diaphragm, and other organs in the chest cavity. These surgical procedures can be either open or minimally invasive (using small incisions and specialized instruments) and are performed to diagnose, treat, or manage various medical conditions affecting the thoracic organs, such as:
1. Lung cancer: Thoracic surgeons perform lung resections (lobectomy, segmentectomy, wedge resection) to remove cancerous lung tissue. They may also perform mediastinal lymph node dissection to assess the spread of the disease.
2. Esophageal surgery: Surgeries like esophagectomy are performed to treat esophageal cancer or other conditions affecting the esophagus, such as severe GERD (gastroesophageal reflux disease).
3. Chest wall surgery: This includes procedures to repair or replace damaged ribs, sternum, or chest wall muscles and treat conditions like pectus excavatum or tumors in the chest wall.
4. Heart surgery: Thoracic surgeons collaborate with cardiac surgeons to perform surgeries on the heart, such as coronary artery bypass grafting (CABG), valve repair/replacement, and procedures for treating aneurysms or dissections of the aorta.
5. Diaphragm surgery: Procedures like diaphragm plication are performed to treat paralysis or weakness of the diaphragm that can lead to respiratory insufficiency.
6. Mediastinal surgery: This involves operating on the mediastinum, the area between the lungs, to remove tumors, cysts, or other abnormal growths.
7. Pleural surgery: Procedures like pleurodesis or decortication are performed to manage conditions affecting the pleura (the membrane surrounding the lungs), such as pleural effusions, pneumothorax, or empyema.
8. Lung surgery: Thoracic surgeons perform procedures on the lungs, including lobectomy, segmentectomy, or pneumonectomy to treat lung cancer, benign tumors, or other lung diseases.
9. Tracheal surgery: This includes procedures to repair or reconstruct damaged trachea or remove tumors and growths in the airway.
10. Esophageal surgery: Collaborating with general surgeons, thoracic surgeons perform esophagectomy and other procedures to treat esophageal cancer, benign tumors, or other conditions affecting the esophagus.
Nonpenetrating wounds are a type of trauma or injury to the body that do not involve a break in the skin or underlying tissues. These wounds can result from blunt force trauma, such as being struck by an object or falling onto a hard surface. They can also result from crushing injuries, where significant force is applied to a body part, causing damage to internal structures without breaking the skin.
Nonpenetrating wounds can cause a range of injuries, including bruising, swelling, and damage to internal organs, muscles, bones, and other tissues. The severity of the injury depends on the force of the trauma, the location of the impact, and the individual's overall health and age.
While nonpenetrating wounds may not involve a break in the skin, they can still be serious and require medical attention. If you have experienced blunt force trauma or suspect a nonpenetrating wound, it is important to seek medical care to assess the extent of the injury and receive appropriate treatment.
The chordae tendineae are cord-like tendons that attach the heart's papillary muscles to the tricuspid and mitral valves in the heart. They play a crucial role in preventing the backflow of blood into the atria during ventricular contraction. The chordae tendineae ensure that the cusps of the atrioventricular valves close properly and maintain their shape during the cardiac cycle. Damage to these tendons can result in heart conditions such as mitral or tricuspid valve regurgitation.
Chest pain is a discomfort or pain that you feel in the chest area. The pain can be sharp, dull, burning, crushing, heaviness, or tightness. It may be accompanied by other symptoms such as shortness of breath, sweating, nausea, dizziness, or pain that radiates to the arm, neck, jaw, or back.
Chest pain can have many possible causes, including heart-related conditions such as angina or a heart attack, lung conditions such as pneumonia or pleurisy, gastrointestinal problems such as acid reflux or gastritis, musculoskeletal issues such as costochondritis or muscle strain, and anxiety or panic attacks.
It is important to seek immediate medical attention if you experience chest pain that is severe, persistent, or accompanied by other concerning symptoms, as it may be a sign of a serious medical condition. A healthcare professional can evaluate your symptoms, perform tests, and provide appropriate treatment.