Flail Chest Segment?

[Chief1C]

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?

We still carry sandbags.

[Dustdevil]

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.

Completely disagree. The injury you describe is not a threat to the spinal cord, which is the only indication for spinal immobilisation. You are more likely to aggravate this patients injuries by attempting to forcibly immobilise him, when everything in his being is telling him not to lay flat, he is to aggravate them by assuming a position of comfort. Although, comfort is certainly a relative term in this context.

[Richard B the EMT]

4cmk6, as for your carrying sandbags, are your arms stronger for carrying them?

lol

[Chief1C]

4cmk6, as for your carrying sandbags, are your arms stronger for carrying them?

lol

:roll:

[Lone Star]

Per my protocols in Michigan, the flail chest is to be splinted with a pillow, held in place by the patients arm in a sling/swath combination. Assist with ventilations if necessary. Again, per protocol, because of the MOI, full spinal immobilization is required.,

[tniuqs]

You are more likely to aggravate this patients injuries by attempting to forcibly immobilise him, when everything in his being is telling him not to lay flat, he is to aggravate them by assuming a position of comfort. Although, comfort is certainly a relative term in this context.

This reminds me of a History lesson I recieved before I was thrown out of Texas, I believe that it was Paramedic Robert Waddel who clarified the words of Napoleans Surgeon (in passing he was a pioneer in many medical current practices even today)

"Splint in the position of Comfort" was the surgeons directions to his litter bearers.

cheers

[firedoc5]

Completely disagree. The injury you describe is not a threat to the spinal cord, which is the only indication for spinal immobilisation. You are more likely to aggravate this patients injuries by attempting to forcibly immobilise him, when everything in his being is telling him not to lay flat, he is to aggravate them by assuming a position of comfort. Although, comfort is certainly a relative term in this context.

Did you read my entire post? I may have not worded it right though. I'm not saying all flail chests need to be spinal immobile. But most of the flail chest I had was from MVA or other trauma that would call for spinal precautions. I know of several times that later on the pt. was x-rayed and showed compression fx's. and / or subluxation (torqued) vertebrae. Most requiring spinal surgery. I was just trying to point out possibilities, not trying to make a blanket statement.

[Dustdevil]

I'm not saying all flail chests need to be spinal immobile. But most of the flail chest I had was from MVA or other trauma that would call for spinal precautions. I know of several times that later on the pt. was x-rayed and showed compression fx's. and / or subluxation (torqued) vertebrae. Most requiring spinal surgery. I was just trying to point out possibilities, not trying to make a blanket statement.

Sorry for the misunderstanding. It just seemed pretty clear to me that...

With any flail chest spinal immob. should be a must.

...was meant to be a blanket statement.

On the other hand, I certainly didn't mean to make a blanket statement either. According to both the Nexus and Canadian Spinal criteria, distracting, painful injuries are inclusionary factors for Selective Spinal Immobilisation (SSI). Consequently, there are absolutely going to be MOI indications for immobilisation in many of these patients. My point is that there can be no cookbook answer to apply like a blanket, because each patient's situation is going to be different. We just cannot automatically strap these people down -- potentially sacrificing their airway -- because some cookbook says "any" patient with flail chest "must" be boarded.

[firedoc5]

Sorry for the misunderstanding. It just seemed pretty clear to me that...

...was meant to be a blanket statement.

On the other hand, I certainly didn't mean to make a blanket statement either. According to both the Nexus and Canadian Spinal criteria, distracting, painful injuries are inclusionary factors for Selective Spinal Immobilisation (SSI). Consequently, there are absolutely going to be MOI indications for immobilisation in many of these patients. My point is that there can be no cookbook answer to apply like a blanket, because each patient's situation is going to be different. We just cannot automatically strap these people down -- potentially sacrificing their airway -- because some cookbook says "any" patient with flail chest "must" be boarded.

Me and my typing getting ahead of my thoughts. That's got me into trouble before. :roll:

[Camulos]

In my book any pt who has suffered a significant enough force to cause a clinically evident flail segment in the field definitely deserves spinal immobilisation. I understand the term “distracting injury” is not well defined by the existing C-Spine clearance protocols, however I personally believe that at LEAST two ribs which have been fractured in at LEAST two places definitely qualifies as a distracting injury. And any flail that you can usually detect prehospital has to be much bigger than this basic definition to be recognised clinically. So if I see it in the field, then that pt gets a collar and board. I recognise that this has the potential to cause compromise to both airway and breathing. If so they get a tube and PPV – which will effectively treat the flail anyway.

Stay safe,

Curse :evil: