Flail chests

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Ken

Now I feel you are talking nonsense! We use limited fluid in our blunt
chest trauma cases and still we see the flails! Interesting not in the
first few days however, rather as they are weaning and the fluid balance
is negative.

While they are on positive pressure ventilation they don't flail, once
they are weaned they start to flail because of the need for increased
negative inspiratory pressure in response to the consolidated contused
lung that underlies the fractures. Keeping them on PSV/PEEP or CPAP/BiPAP
ablates this response and they heal over the next 10-14 days

Maybe you are not seeing the flail as most of the acute severe contusions
are intubated and positive pressure ventilated.

Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Senior Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban, South Africa

> In the absence of fluid overload in the ambulance or the EC, "flail"
> segments of multiple rib fractures are almost NEVER seen.     Flail Chest
> should
> be considered to be an iatrogenic complication of the  protocols which
> start
> 2 large bore IVs and flood the patient with  fluid.       Yes, I do
> believe
> that ATLS needs its  fluid resuscitation section revised.
>
> k
>
>
> In a message dated 8/17/2010 11:08:37 A.M. Central Daylight Time,
> Ronald.Gross at baystatehealth.org writes:
>
> Funny  timing here, Mark!  I have been struggling to pull a study
> together,
> and  was hoping to work with the guys on the west coast to get it going
> since they  apparently already have a protocol in search of a funding
> source.
> Unfortunately, it looks like they want to make a go of it on their own.
> Coincidentally, the Boston group and I talked about this in the recent
> past,
> and at the same time we just hired a new partner who just happens to have
> really good results that they have gathered at his previous  shop.
>
> Bottom line - stay tuned, 'cause I am going to reach out to y'all  very
> shortly to hopefully move this almost dead study forward into the light
> again!
>
> While I have your attention - has anything ever come of that  other issue
> you and I had discussed several months ago?  I hadn't heard  any news, and
> so
> I assumed that it was just a lot of nothing......at least I  hope so!  Let
> me know, if you have the time.
>
> Best  wishes,
> Ron
>
>
>
>
> -----Original Message-----
> From:  trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On  Behalf Of Mark Forrest
> Sent: Tuesday, August 17, 2010 10:21 AM
> To:  Trauma-List [TRAUMA.ORG]
> Subject: Flail chests
>
> Ron presented some of  the evidence gathering for early fixation of
> selected large flails at the ITC  recently. He mentioned Tanaka's work
> (2002) and a
> more recent study by Trunkey  and Mayberry's (2009).
> A further RCT had been proposed, is anyone aware of  any results or
> progress.
> Does anyone have guidelines to consider early  fixation to assist weaning?
> Regards
> Mark F
> Uk
>
> Sent from my  iPhone
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