Treatment
Treatment of the flail chest initially follows the principles of advanced trauma life support. Further treatment includes:
- Good analgesia including intercostal blocks, avoiding narcotic analgesics as much as possible. This allows much better ventilation, with improved tidal volume, and increased blood oxygenation.
- Positive pressure ventilation, meticulously adjusting the ventilator settings to avoid pulmonary barotrauma.
- Chest tubes as required.
- Adjustment of position to make the patient most comfortable and provide relief of pain.
- Aggressive pulmonary toilet
Surgical fixation can help in significantly reducing the duration of ventilatory support and in conserving the pulmonary function.
A patient may be intubated with a double lumen tracheal tube. In a double lumen endotracheal tube, each lumen may be connected to a different ventilator. Usually one side of the chest is affected more than the other, so each lung may require drastically different pressures and flows to adequately ventilate.
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