Rib Fractures, Flail Chest, and Pulmonary Contusion

Abstract

Blunt chest trauma accounts for a significant proportion of debilitating and life-threatening injuries. Rib fractures are notoriously painful and can lead to prolonged hospitalization, contribute to the development of pneumonia and respiratory failure, and delay outpatient recuperation significantly. Flail chest, along with chest wall deformity, the most severe of chest wall injuries, is associated with significant acute morbidity and mortality. Pulmonary contusion often accompanies blunt chest wall trauma and when diffuse will result in respiratory failure regardless of other injuries. Pulmonary lacerations, pneumatoceles, and even lobar infarction can occur. In this review, we describe the development of current principles of management of rib fractures, flail chest, and pulmonary contusion. Emerging or unclarified strategies include the importance of acute pain control of rib fractures to alleviate the development of chronic pain, the role of rib fracture operative reduction/internal fixation (ORIF) in severe chest wall trauma, and the use of surfactant and dual lung ventilation for severe pulmonary contusion.

A Preventative Respiratory Protocol to Identify Trauma Subjects at Risk for Respiratory Compromise on a General In-Patient Ward

“…[1][2][3][4][5][6][7][8][9][10] Respiratory complications can lead to adverse hospital events, such as unplanned admission to the ICU, prolonged hospital stays, higher rates of mortality, and increased consumption of healthcare resources. [11][12][13][14][15] Many adverse events are preventable. 16,17 There are numerous reasons why patients are at greater risk for pulmonary complications after trauma, especially patients who sustain blunt chest injury.…”

“…16,17 There are numerous reasons why patients are at greater risk for pulmonary complications after trauma, especially patients who sustain blunt chest injury. 9,14,18,19 Rib fractures, pulmonary contusions, and other chest conditions frequently impede respiratory function at several levels. First, fractures of the rib cage put the patient at a mechanical disadvantage, increasing the effort required with inspiration and decreasing maximal cough strength.…”

“…First, fractures of the rib cage put the patient at a mechanical disadvantage, increasing the effort required with inspiration and decreasing maximal cough strength. 8,14,19,20 Decreased lung volume and atelectasis may be the first events in a cascade leading to pulmonary complications. 21 Second, the pain associated with these injuries makes patients unwilling or unable to take deep breaths unassisted.…”

“…21 Second, the pain associated with these injuries makes patients unwilling or unable to take deep breaths unassisted. 9,10,14,19,22 This can result in reduction in lung volumes for hours or even days. Third, trauma patients may experience extended periods of immobility or receive medications that depress respiratory drive and interfere with pulmonary function.…”

Thorax Trauma Severity Score sebagai Prediktor Acute Respiratory Distress Syndrome pada Trauma Tumpul Toraks

“…Skor ini juga mudah dilakukan oleh klinisi sebagai skirining awal pada pasien trauma tumpul toraks. 1,2,4,[12][13][14][15] Dianjurkan untuk menggunakan TTSS sebagai alat diagnostik awal dalam memrediksi ARDS pada kasus trauma tumpul toraks. Deteksi dini risiko ARDS merupakan penentu untuk dijadikan pemandu manajemen awal dan keperluan ventilasi mekanik.…”