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Thoracic
US
Thoracic trauma accounting for + 20%
of all trauma death in the US
Most of thoracic injury sustain in motor
vehicle crash is blunt in nature
Blunt Injury
Forces
Compressi
on
Shearing
Blast
The
Requirement :
Injury mechanism : Motor vehicle crash
Physical examination
Paradoxical motion
Severe chest wall pain
Respiratory insufficiency
Decrease breath sound
Primary
At present:
Admission to trauma ICU
Aggressive pulmonary toilet
Pain control
High
Indication:
Other intrathoracic injury which require
thoracotomy
Unsuccessfully weaned from mechanical
ventilator
Severe chest instability
Persistent pain secondary to malunion
fracture
Persistent/progressive loss of pulmonary
function
(A) Chest radiograph showing volume loss and rib cage deformity after
multiple left-sided rib fractures. (B) Postoperative film at 1 month
following metallic strut placement. Note improved volume in the left
hemithorax. (From Haasler G. Open fixation of flail chest after blunt
trauma. Ann Thorac Surg 1990;49:994; with permission. Copyright
Flail
chest is an uncommon
consequence of blunt trauma
Isolated flail chest may be successfully
managed with aggressive pulmonary
toilet including facemask oxygen, CPAP,
and chest physiotherapy
Adequate analgesia is of paramount
importance in flail chest patient
Early intubation and mechanical
ventilation is paramount in patients
with refractory respiratory failure or
other serious traumatic injuries
Surgical
stabilization is associated
with a faster ventilator wean, shorter
ICU time, less hospital cost, and
recovery of pulmonary function in a
select group of patients with flail
chest