連枷胸(Flial chest)

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)

Ref: ATLS, 9th ed.

診斷：

• 臨床診斷，視診和觸診palpation of abnormal respiratory motion and 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：

• pulmonary contusion所造成的lung injury和restricted chest wall movement associated with pain 是造成hypoxia 的主因
• Patients with flail chest have deranged respiratory mechanics and usually require positive pressure ventilation.

治療要點

1. initial treatment: adequate ventilation, administration of humidifed oxygen and fluid resuscitation(avoid volume overload)
2. definitive treatment: adequate oxygenation, administer judiciously and provide analgesia to improve ventilation。
3. 止痛應避免respiratory depression
4. local anesthetics 包含intermittent intercostal nerve block and intrapleural , extrepleural, or epidural anesthsia

參考資料

1. ATLS, 9th ed.
2. Flail chest in Medscape
3. Acute care surgery