Movable rib plate due to chest trauma

Posted by Master, Doctor Nguyen Ngoc Quang - Head of Cardiovascular - Thoracic Surgery - General Surgery - Intensive Care Unit - Vinmec Times City International Hospital

Mobile rib array usually occurs at the position of the most lateral rib array or movable rib array is the sternum and posterior rib array, is a very serious injury of the thoracic cavity that requires immediate surgical emergency, if slow delay can cause severe respiratory and circulatory disorders for patients.

Mobile rib array is a characteristic lesion of thoracic trauma that fractures a series of ribs that render part of the ribcage unstable and move counterclockwise during the breathing cycle. Often accompanied by contusion to the lung depending on the severity. Lungs below the lungs often have lung damage.
The condition is that the rib must be broken in 2 places on one arch and on 3 consecutive ribs. Common in very strong trauma. The consequences of a mobile rib array are severe respiratory and circulatory failure.

2.1 The primary goal of treatment is to maintain adequate ventilation
Maximal analgesia or anesthesia Maximal analgesia is important for the patient to be able to cough and to maintain the ability to breathe deeply, thereby helping Clean the lungs and limit atelectasis. Patients are often selected for systemic morphine analgesia. Epidural analgesia (widely deployed at Vinmec) is a very effective pain reliever method in pain control but does not cause the side effects of Morphine, which doctors are afraid to use. for patients. Prevention of atelectasis Regular suction of sputum to avoid atelectasis and oropharyngeal stagnation Breathing support: Blowing balloons, assisting coughs, breathing flowmeters to assess vital capacity An extremely important measure is physical Respiratory therapy: Vibration, breathing exercises, this method is even more effective if the patient has been given maximum pain relief.

Non-invasive ventilation Non-invasive mechanical ventilation is a simple, minimally invasive, and well-tolerated technique that can be applied to patients with a mobile rib array. During mechanical ventilation, the machine will create a continuous positive pressure, which can provide additional pressure to help the patient's chest always be stretched with a maximum pressure => thus limiting the negative pressure range at the stroke. inhale, and thus the thorax will not move paradoxically during the breathing cycle. In addition, non-invasive mechanical ventilation also plays a role in preventing atelectasis and mobilizing healthy parts of the lung.

Many studies have shown that patients receiving noninvasive ventilation have lower rates of nosocomial infections and fewer deaths. Invasive mechanical ventilation Used in cases of severe chest trauma or associated with other types of systemic trauma Injury to the large mobile ribs and contusion of the lung so large that it cannot be resolved with noninvasive ventilation Indications for invasive mechanical ventilation include: Patient is comatose or has impaired consciousness unable to receive non-invasive mechanical ventilation. Major pulmonary contusion injury causing severe respiratory failure PaO2 <80 mmHg Has a state of shock Has chronic lung disease associated with significant lung parenchymal damage Fracture from 8 ribs or more Age> 65 2.2 Surgical indications
Patient needs thoracic surgery for a reason of serious injury other than the mobile rib array: Heavy bleeding, uncontrolled pneumothorax, trauma to the heart, aorta. Multiple rib fractures slow to heal and cannot be removed from the ventilator (not due to lung contusion) Chest wall instability Patient is in severe pain due to moving rib plates Decreased respiratory function, unresponsive to ventilator The principle of surgery is to fix the rib plate. Many studies show that the surgical group of patients has a shorter time of mechanical ventilation and a shorter hospital stay. Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in neurological examination and treatment, patients can completely rest in peace. Center for examination and treatment at the Hospital.
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