Flail Chest Segment?

[bball160]

Hey guys i am currently an emt-b student and just recently had my first practical examination. In my trauma station I had a 45 y.o male who was the victim of a MVA roll over. He had resperations at 6pm in which i had my partner assist in ventilation with the BVM. Along with this my patient had a frail chest segment in which i had my other partner place direct pressure on. I ended up passing that portion but some proctors disagreed and said it needed to be splinted. How would you guys treat this?

[Chief1C]

Flail Chest - BLS? PPBVM would be a good start if they can't maintain. You'll want ALS, clearly, it's a trauma. Consider various modes of transit, depending on the condition, your location, etc.

BLS treatment, IMO. Splint it how you were taught. Either a couple trauma dressings and 2 or 3" tape; or cravats; less likely to move (or pop) like some who suggest using 1000ml IV bags or other heavy items.. If they're awake, alert, and not in any danger of having that change. You can kind of have them support it on their own too, but I'd still immobilize to protocol. Don't let them move around too much.

[bball160]

Sorry i was meaing flail lol. But for the BLS (which i plan on working on soon) i was thinking i would possibly end up placing some form of splint in between the patient and the securing straps of the cot depending on the location of the segment. Would that work out fairly well in your opinion?

[Chief1C]

You have to take him off the stretcher at some point.

I'd use a strong, cloth tape in 3"; two multi-trauma dressings folded and tape it on nice and tight. That could be an issue if he's diaphoretic. You could always tie cravats together and go all the way around. However, I've done it several times, and always used tape. Early 90's single cab pick up, no belt, no bag... On a board in the roadway, left chest immobilized, 20ga. cath sticking out of his chest, intubated; and the MAST on for bi-lat femurs and pelvis.

[Dustdevil]

Like 99.9 percent of all emergency patients you will see as an EMT-B, there is nothing you can or should do for this patient that will make a difference. Not too much more than a medic can do, for that matter. In many systems, there is nothing more they can do. 1.0 FiO[sub:ff414406ac]2[/sub:ff414406ac], position of comfort, and rapid transportation to a trauma centre.

EDIT: I would add that it is important that these patients be carefully screened to rule out c-spine precautions instead of automatically immobilising them because of trauma. It is best that they are not immobilised, if at all possible, so don't just throw them on a board because of MOI.

[tniuqs]

With RR of 6 bpm, its not looking good from the onset, Positive Pressure Ventilation ie (splint from within) would be my best advice, (watch the duck valve on the bagger and try to syc breaths) the old school use if external form of splinting does nothing accept give you something to before the patient expires, this depends on the size of the flail segment, but again if the patient is down to 6 bpm ... its not looking very positive at all, I would highly suspect "agonal" type resps.

You need ALS providers and asap, with proper RSI capabilities, chest decompression (I use 10 ga. 20 will clot off way to fast) the use of PEEP (Positive Expiratory End Pressure) and very serious consideration to Hypovolemia as the costal arteries when lacerated can be a death sentence in itself.

cheers and good luck with the fictious senarios.

[mobey]

I dunno, I have had 2 patients with a flail chest and you could not tell by looking at them. And no, there was no way I could properly palpate, drop a bag of salin or anything else on it without getting smacked!! In the early stages of a flail chest the muscles spasm and splint the fracture so you don't have to get too carried away with fancy crap. A pillow or towel between thier hand and thier chest is all I have used when they say it feels better to put a bit of pressure on it.

That being said I am sure some people have seen this: http://www.youtube.com/watch?v=e0VNBDbr67U...feature=related

[spenac]

I'm with Mobey just let them hug a pillow. Then that helps them feel better, perhaps even a little placebo effect. Never used anything but the pillow. Now for advanced you may even have to chest decompress, but you'll get that when you are getting your paramedic degree.

[firedoc5]

We usually went with either a sandbag or a flattened pillow with tape. With any flail chest spinal immob. should be a must. I've seen too many times where the flailed segment is up front on the side, then x-rays showed disconnection from the ribs from the spinal areas.

That might be hard to do always, especially if having orthropnea and can not tolerate a flat lay. But be sure to have them fastened down good and discourage any movement. If ALS and resp. are adequate, pain management, high flow O2. Watch for pneumo/ hemo-thorax.

[Richard B the EMT]

We used to "splint" by taping a sandbag onto the flail section. Now, just told to apply a "bulky" dressing, like a trauma dressing or the pillow.

Lotta differences 'tween 1973 and today, huh?