The Management of Flail Chest - Tata
-
Upload
pervinder-singh -
Category
Documents
-
view
218 -
download
0
Transcript of The Management of Flail Chest - Tata
-
8/9/2019 The Management of Flail Chest - Tata
1/21
Brian L. Pettiford, MD, James D. Luketich, MD,Rodney J. Landreneau, MD
Thorac Surg Clin ! "#$$!% #&'((
-
8/9/2019 The Management of Flail Chest - Tata
2/21
Thoracic trauma is )uite common in the*S
Thoracic trauma accounting for + #$
of all trauma death in the *SMost of thoracic in-ury sustain in motor
ehicle crash is /lunt in nature
Blunt InjuryForces
Compression
Shearing Blast
-
8/9/2019 The Management of Flail Chest - Tata
3/21
The common result of com0ressie in-uryto the thoracic cage is ri/ fracture
1lail chest occurs in $ of thoracic
trauma cases, 2ith mortality rate/et2een $3&
-
8/9/2019 The Management of Flail Chest - Tata
4/21
Schematic of 4ail chest 0hysiology. "1rom May/erry J, Trunkey D. Thefractured ri/ in chest 2all trauma. Chest Surg Clin 5 6m 77!8!9#&(8
2ith 0ermission.%
-
8/9/2019 The Management of Flail Chest - Tata
5/21
Re)uirement 9 :n-ury mechanism 9 Motor ehicle crash
Physical e;amination▪ Parado;ical motion
▪ Seere chest 2all 0ain
▪ Res0iratory insu 6/dominal CT Scan
-
8/9/2019 The Management of Flail Chest - Tata
6/21
Primary focus 9 6de)uate entilationmanagement
Mid 7&$s :ntermiten 0ositie0ressure entilation 2as st used
Late 7?$s3early 7!$s
tracheostomy+ mechanical entilation
Mid 7!$s com/ination of 4uid
restriction, corticosteroid, aggressie0ulmonary toilet,> 0ain killer
-
8/9/2019 The Management of Flail Chest - Tata
7/21
6t 0resent96dmission to trauma :C*
6ggressie 0ulmonary toiletPain control
-
8/9/2019 The Management of Flail Chest - Tata
8/21
6de)uate 6nalgesia fasilitates0ulmonary toilet an dearly mo/ili@ation
.Sistemic A0ioid#.Control anasthesia 2ith continuos
infusion(.Bu0iacain intercostal nere /lock
.0idural analgesia&. Thoracic 0araerte/ral /lock?.5S:D
-
8/9/2019 The Management of Flail Chest - Tata
9/21
igh mortality rate is 0rimarily caused/y associated in-ury
:n-ury Seerity Score ":SS% has /eenuseful to determine the outcome
:ndication of arly Mechanical Eentilator9 :SS F #(
ead or truncal organ in-ury Shock on admission
Blood transfusion 2ithin the st # hour
-
8/9/2019 The Management of Flail Chest - Tata
10/21
:ndication9 Ather intrathoracic in-ury 2hich re)uire
thoracotomy
*nsuccessfully 2eaned from mechanicalentilator
Seere chest insta/ility
Persistent 0ain secondary to malunionfracture
PersistentG0rogressie loss of 0ulmonaryfunction
-
8/9/2019 The Management of Flail Chest - Tata
11/21
"6% Chest radiogra0h of Lu)ue rod H;ation of 0osterolateral 4ail cheststa/ili@ed 2ith ortho0edic e;ternal H;ation deices. "B% Plain Hlma00ro;imately ( months after deice remoal. "1rom Landreneau R,
inson J, a@elrigg S, et al. Strut H;ation of an e;tensie 4ail chest. 6nn Thorac Surg 778&9!8 2ith 0ermission. Co0yright 77, The
-
8/9/2019 The Management of Flail Chest - Tata
12/21
"6% Chest radiogra0h sho2ing olume loss and ri/ cage deformity aftermulti0le left3sided ri/ fractures. "B% Posto0eratie Hlm at monthfollo2ing metallic strut 0lacement. 5ote im0roed olume in the left
hemithora;. "1rom aasler I. A0en H;ation of 4ail chest after /lunttrauma. 6nn Thorac Surg 77$879778 2ith 0ermission. Co0yright
-
8/9/2019 The Management of Flail Chest - Tata
13/21
Judet Struts and a00lication 0liers. "1rom Tanaka , ukioka T, amaguti , et al. Surgical sta/ili@ation of internal 0neumaticsta/ili@ationK 6 0ros0ectie randomi@ed
study of management of seere 4ail chest 0atients. J Trauma#$$#8!#78 2ith 0ermission.%
-
8/9/2019 The Management of Flail Chest - Tata
14/21
Schematic of ste0s through ?for (.&3mm aceta/ularreconstruction 0late H;ation
along each side of the fracturesite. "1rom Ayar@un J, Bush 6,McCormick JR, et al. *se of (.&3mm aceta/ular reconstruction0latesfor internal H;ation of 4ail chest
in-uries. 6nn Thorac Surg778?&9!#8 2ith 0ermission.
-
8/9/2019 The Management of Flail Chest - Tata
15/21
Disadatage of the metal 0rothesis9 :t a/sor/s most of the stress directed
to2ard the aected ri/, resulting indelayed 2ound healing
The rigidity e;ceeds that of theaected ri/s may result in scre2loosening, 0late dislocation, orchronic chest 2all 0ain, re)uiringsu/se)uent remoal
-
8/9/2019 The Management of Flail Chest - Tata
16/21
6/sor/a/le 0olyactide 0olymer 0lates >scre2com/ine 2ith cerclage Promotes fracture healing
Preclude of the need for 0rothesis remoal
Long term /eneHt of surgicalmanagement
include the restoration of normal chest2all geometry and im0roe 0ulmonaryfunction testing
-
8/9/2019 The Management of Flail Chest - Tata
17/21
Chest Hlms made "6% 0reo0eratiely,"B% immediately 0osto0eratiely, and
"C% year 0osto0eratiely. "1romAyar@un J, Bush 6, McCormick JR, et al.*se of (.&3mm aceta/ularreconstruction 0lates for internalH;ation of 4ailchest in-uries. 6nn Thorac Surg
778?&9!(8 2ith 0ermission.Co ri ht 77 The Societ of
-
8/9/2019 The Management of Flail Chest - Tata
18/21
;am0le of a/sor/a/le reconstruction0late secured 2ith a/sor/a/le suturecerclage. "1rom May/erry J, Terhes J,llis T, et al. 6/sor/a/le 0lates for ri/fracture re0air9 0reliminarye;0erience. J Trauma #$$(8&&9(?8
2ith 0ermission.%
-
8/9/2019 The Management of Flail Chest - Tata
19/21
1lail chest is an uncommonconse)uence of /lunt trauma
:solated 4ail chest may /e successfully
managed 2ith aggressie 0ulmonarytoilet including facemask o;ygen, CP6P,and chest 0hysiothera0y
6de)uate analgesia is of 0aramount
im0ortance in 4ail chest 0atient arly intu/ation and mechanicalentilation is 0aramount in 0atients2ith refractory res0iratory failure orother serious traumatic in-uries
-
8/9/2019 The Management of Flail Chest - Tata
20/21
Surgical sta/ili@ation is associated2ith a faster entilator 2ean, shorter
:C* time, less hos0ital cost, andrecoery of 0ulmonary function in a
select grou0 of 0atients 2ith 4ailchest
-
8/9/2019 The Management of Flail Chest - Tata
21/21