11/35. An unusual cause of chest pain.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.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
12/35. Definitive management of acute cardiac tamponade secondary to blunt trauma.Blunt cardiac injuries are a leading cause of fatalities following motor-vehicle accidents. Injury to the heart is involved in 20% of road traffic deaths. Structural cardiac injuries (i.e. chamber rupture or perforation) carry a high mortality rate and patients rarely survive long enough to reach hospital. Chamber rupture is present at autopsy in 36-65% of death from blunt cardiac trauma, whereas in clinical series it is present in 0.3-0.9% of cases and is an uncommon clinical finding. patients with large ruptures or perforations usually die at the scene or in transit--the rupture of a cardiac cavity, coronary artery or intrapericardial portion of a major vein or artery is usually instantly fatal because of acute tamponade. The small, rare, remaining group of patients who survive to hospital presentation usually have tears in a cavity under low pressure and prompt diagnosis and surgery can now lead to a survival rate of 70-80% in experienced trauma centres. As regional trauma systems evolve, patients with severe, but potentially survivable cardiac injury are surviving to ED. Two distinct syndromes are apparent--haemorrhagic shock and cardiac tamponade. Any patient with severe chest trauma, hypotension disproportionate to estimated loss of blood or with an inadequate response to fluid administration should be suspected of having a cardiac cause of shock. For patients with severe hypotension or in extremis, the treatment of choice is resuscitative thoracotomy with pericardotomy. Closed chest cardiopulmonary resuscitation is ineffective in these circumstances. Blunt traumatic cardiac injury presenting with shock is associated with a poor prognosis. The majority of survivors of blunt or penetrating cardiac injury present to the ED/trauma centre with vital signs. The main pathophysiologic determinant for most survivors is acute pericardial tamponade. The presence of normal clinical signs or normal ECG studies does not exclude tamponade. In recent years the widespread availability and use of ultrasound for the initial assessment of severely injured patients has facilitated the early diagnosis of cardiac tamponade and associated cardiac injuries. Two cases of survival from blunt traumatic cardiac trauma are described in the present paper to demonstrate survivability in the context of rapid assessment and intervention.- - - - - - - - - - ranking = 0.33333333333333keywords = chest (Clic here for more details about this article) |
13/35. flail chest in a neonate resulting from nonaccidental trauma.The authors present a 21-day-old infant who sustained a flail chest as a result of nonaccidental trauma. Initial treatment included endotracheal intubation and mechanical ventilation for hypoxemic respiratory failure followed by the administration of continuous positive airway pressure by nasal cannula. Further evaluation resulted in the identification of nonaccidental as the mechanism of injury. The pathophysiology of flail chest, its etiology, and treatment options are reviewed. In the absence of a documented history of significant thoracic injury or the presence of metabolic bone disease, nonaccidental trauma is the most likely diagnosis in infants and children with a flail chest.- - - - - - - - - - ranking = 1.1666666666667keywords = chest (Clic here for more details about this article) |
14/35. Successful use of non-invasive positive pressure ventilation in a complicated flail chest.The current advanced trauma life support manual states that patients with significant hypoxia namely, SaO2 <90% on room air as a result of pulmonary contusion should be intubated and ventilated within the first hour of injury. Recently, several researchers have shown improved outcomes when patients with acute respiratory failure are managed with non-invasive positive pressure ventilation NIPPV. Trauma patients may also benefit from this therapy. We report a case of 15-year-old boy with isolated flail chest and pulmonary contusion, who was intubated in the emergency room, and was managed successfully with the NIPPV in the intensive care unit ICU despite, having had aspiration pneumonia early in the course of his stay. After initial stabilization, he failed a spontaneous breathing trial. Due to absence of contraindications to the use of NIPPV, the patient was extubated on day 7 from pressure support ventilation of 15 cmH2O and positive end expiratory pressure of 8 cmH2O to immediate NIPPV use. Three days later after a total of 50 hours of NIPPV use in the ICU the patient was successfully discharged home.- - - - - - - - - - ranking = 15.113865784499keywords = breathing, chest (Clic here for more details about this article) |
15/35. External fixation of the sternum for thoracic trauma.A flail chest with a manubriosternal separation in a man with multiple injuries was treated with an external fixator applied to the sternum and the manubrium. Pain and ventilatory function were improved, permitting immediate postoperative extubation and prompt patient mobilization. The external fixator was removed after fracture union at 2 months. One year after injury, the patient's pulmonary function was normal. External fixation is an alternative to other methods of sternal fracture stabilization.- - - - - - - - - - ranking = 0.16666666666667keywords = chest (Clic here for more details about this article) |
16/35. The costal hook: an indicator of occult flail segment in chest trauma.The presence of a hook-like configuration at the site of rib fracture reflects significant rotational displacement. Such displacement can occur only as the result of a further fracture at another site within the same rib and is therefore indicative of a flail segment injury even if a second fracture site is not clearly identified. This appearance is illustrated and termed the 'costal hook' sign.- - - - - - - - - - ranking = 0.66666666666667keywords = chest (Clic here for more details about this article) |
17/35. Strut fixation of an extensive flail chest.The indications for and preferred approaches to operative stabilization of posttraumatic chest wall instability are uncertain. We suggest this simple, rapid, and effective approach to surgical stabilization by Luque rod strutting of the flail segment when operation is required.- - - - - - - - - - ranking = 0.83333333333333keywords = chest (Clic here for more details about this article) |
18/35. Open fixation of flail chest after blunt trauma.Progressive left chest volume loss developed in a patient with severe flail chest despite reasonable oxygenation without intubation. Because of this chest volume loss, pain, and shortness of breath, she underwent open chest wall repair using multiple metallic struts. Rapid recovery ensued, despite a perforated duodenal ulcer on postoperative day 1. Benefits of open fixation of severe flail chest are clearly demonstrated and should be considered instead of prolonged ventilation or supportive care alone for select patients.- - - - - - - - - - ranking = 1.5keywords = chest (Clic here for more details about this article) |
19/35. Effect of temporary external stabilization on ventilator weaning after sternal resection.The role of mechanical fixation of the chest wall in the treatment of flail chest remains controversial. We report a case of flail chest resulting from major sternal resection. The application of a temporary external stabilization device improved pulmonary mechanics by decreasing the respiratory rate from 36/min to 10/min while increasing tidal volume and vital capacity from 140 /- 85 ml and 195 /- 90 ml, respectively, to 450 /- 110 ml and 905 /- 310 ml, respectively. The improvement with the temporary device facilitated weaning from mechanical ventilation. We recommend consideration of this technique in selected cases of flail chest resulting from major chest wall resection.- - - - - - - - - - ranking = 0.83333333333333keywords = chest (Clic here for more details about this article) |
20/35. A unique chest wall splint for unilateral agenesis of ribs.Unilateral agenesis of ribs with a "lung hernia," may cause severe respiratory distress in a neonate. Our experience with the use of a temporary external chest splint for stabilization of the congenital flail chest in one patient is presented. The device facilitated extubation and allowed the infant to grow prior to future surgical reconstruction.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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