醫學筆記匯整 ED Notes

定義：
兩根以上相鄰肋骨有兩處以上骨折
造成 paradoxical motion of chest wall (吸氣時內縮, 吐氣時外凸)
 

診斷
臨床診斷, 視診和觸診
Palpation of abnormal respiratory motion, creptiation of rib or cartilage fractures
Blunt trauma patients with paradoxical or reverse motion of a chest wall segment while spontaneously breathing

重要性
造成 hypoxia 的主因 :
 - pulmonary contusion 所造成的lung injury
 - restricted chest wall movement associated with pain

Patients with flail chest have deranged respiratory mechanics
and usually require positive pressure ventilation.

治療要點
Initial treatment : adequate ventilation, administration of humidifed oxygen and fluid resuscitation (avoid volume overload)
Definitive treatment : adequate oxygenation, administer judiciously and provide analgesia to improve ventilation
止痛應避免 respiratory depression

local anesthetics 包含 intermittent intercostal nerve block and intrapleural , extrepleural, or epidural anesthsia