Document Detail


Problems caused by the unstable thoracic wall and by cardiac injury due to blunt injury.
MedLine Citation:
PMID:  3770934     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The treatment of flail chest remains highly controversial. In the literature convincing arguments can be found to support any therapeutic procedure. Newer concepts of mechanical ventilation such as SIMV and CPAP, as well as the use of epidural analgesia, have resulted in a significant reduction in the duration of artificial ventilation. Although the mechanical problems are generally overestimated in this situation, the use of a ventilator is indicated in many cases because of the associated lung damage. Internal fixation of the unstable thoracic wall is restricted to special, selected cases which would otherwise require artificial ventilation, without severe lung injury and without head injury. We found stabilization of bilateral parasternal rib fractures with a retrosternal Sulamaa bar most helpful. Cardiac injuries were present in 16 per cent of our patients admitted after severe blunt thoracic injury. Most of these had myocardial contusion. The analysis of 108 cases of cardiac contusion revealed that every possible variation of ECG can be observed. Repolarization disturbances and impairment of the cardiac rhythm and the conduction system were found most frequently. A ratio of CPK-MB: total CPK of over 6 per cent provides a very significant suspicion of myocardial contusion. The clinical course is characterized by cardiac rhythm disturbances, which required treatment in 40 out of 108 patients, and to a minor extent by heart failure for which treatment was required in 17 patients. Prognosis is generally good with adequate treatment.
Authors:
W Glinz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Injury     Volume:  17     ISSN:  0020-1383     ISO Abbreviation:  Injury     Publication Date:  1986 Sep 
Date Detail:
Created Date:  1986-12-12     Completed Date:  1986-12-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0226040     Medline TA:  Injury     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  322-6     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Analgesia
Contusions / diagnosis,  therapy
Epidural Space
Flail Chest / complications,  therapy*
Heart Injuries / diagnosis,  etiology*,  therapy
Humans
Respiration, Artificial
Respiratory Tract Diseases / etiology
Rib Fractures / therapy
Thoracic Injuries / therapy*
Thoracic Surgery
Wounds, Nonpenetrating / complications,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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