Rib fx, Flail chest Flashcards
______ are the most common injury sustained in blunt thoracic trauma
Rib Fx
True/False
Rib Fractures are usually not sustained in motor vehicle accidents.
False
usually sustained from MVA
True/False
Fractures of the first rib usually indicate severe trauma because of the necessary force to produce such an injury.
True
Physical findings for what?
(1)may cause localized pain, crepitus, pain with inspiration, and dyspnea.
(2) May cause pneumothorax or Hemothorax.
(3) Mortality increases with the number of ribs involved.
(4) The pain associated with rib fractures may lead to hypoventilation, atelectasis, retained secretions, and pneumonia.
Rib Fx
True/false
Mortality decreases with the number of ribs involved.
False
Increases
______ is the screening tool of choice for the detection of rib fractures,
CXR
Up to ___% of rib fractures cannot be detected on CXR.
50
X-rays are usually obtained to identify ____, not specifically for rib fractures
complications
DDx for Rib Fx
(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych
What are the mainstays of treatment for the patient with multiple rib fractures
Rapid mobilization
respiratory support
pain management
Rib FX
_____ is paramount in facilitating adequate ventilation
Pain control
True/False
Incentive spirometry is excellent supportive therapy in stable patients.
True
Mechanical ventilation allows for healing of the ribs and prevention of complications in the patient with ______.
respiratory failure
Rib Fx
What can help prevent hypoventilation and atelectasis?
Continuous body positioning and oscillation therapy
True/False
Rib Fx disposition
Admission is not usually for elderly or other patients with serious underlying lung disease and isolated rib fractures.
False
should be considered
Rib Fx Disposition
Young, healthy patients with isolated rib fractures without evidence of other serious underlying injury.
They do not require routine admittance or serial radiographic studies.
Treatment for Rib FX
Young, healthy patients with isolated rib fractures without evidence of other serious underlying injury.
(a) Pain medication.
(b) Deep breathing exercises.
(c) Incentive spirometry.
Complications for Rib FX, F
(1) Pneumonia
(2) PTX-Pneumothorax
(3) Hemothorax
______occurs when a segment of the chest does not have bony contiguity with the rest of the thoracic cage.
Flail chest
When negative intrathoracic pressure is generated on inspiration, the flail segment moves ______, thus reducing tidal volume.
- inward
- outward
inward
What is usually required to cause flail chest?
Usually a significant blunt force is required, e.g., motor vehicle collision (MVC) or a fall from a height.
What is the major problem from flail chest
respiratory failure due to the underlying pulmonary injury
PE findings of what?
(1) The two major symptoms of this are MSK chest pain and respiratory distress.
(2) Tachypnea with shallow respirations secondary to pain will be seen.
(3) Paradoxical chest wall movement may not be seen in a conscious patient due to splinting of the chest wall.
(4) Crepitus is often present.
(5) When fatigue or underlying pulmonary injury develops, frank respiratory failure may supervene.
flail chest
True/false
Labs are contributory to dx for Flail chest
False
Noncontributory – Dx made based on history and physical exam
True/False
Flail chest Dx is made based on history and physical exam. If possible, obtain Chest X-ray.
True
DDx for Flail chest
(1) Cardiac
(2) Pulmonary
(3) Trauma
(4) GI
(5) Musculoskeletal
(6) Psych
What is the diference between flail chest and rib fx
Flail chest- Respiratory distress,
True/false
Even with marked Flail Chest the patient may be able to compensate initially for the reduced tidal volume by hyperventilating.
True
What is the first line Tx for flail chest?
Supplemental oxygen
Use caution in long term ____ therapy with chronic COPD/Emphysema patients
O2 therapy
What can you use for pain controll for Flail chest?
IV Morphine 2-8 mg
IV Fentanyl 50-100 mcg 1-2h prn
Flail chest pt
Indications for early ventilation would include……
marked hypoxia
inadequate breathing
Approximately ___% of patients will need immediate intubation
50%
True/False
External chest wall supports (taping, sandbags) are indicated for flail chest
False
not indicated
May reduce pain with movement of flail segment but will reduce vital capacity and may worsen respiratory function
Disposition for Flail chest patients
MEDEVAC
Physical findings for what?
(1)may cause localized pain, crepitus, pain with inspiration, and dyspnea.
(2) May cause pneumothorax or Hemothorax.
(3) Mortality increases with the number of ribs involved.
(4) The pain associated with rib fractures may lead to hypoventilation, atelectasis, retained secretions, and pneumonia.
Rib Fx
