Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, Q&A 11

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Student tip: This case is demonstrating the ideal approach to flail segment following trauma

A 2-year-old female neutered 80 Shi Tzu is presented 30 minutes after being attacked by a big dog. The owners had attended the Pet First Aid class at your clinic and transported the dog taped to heavy cardboard (80). T = 38.3°C (101°F); HR = 176 bpm; RR = 30 bpm; CRT = >3 sec; MM pale pink, dry; femoral pulses very weak. The dog appears painful when touched. A 2 cm area of skin and muscle over the caudal to mid-thoracic region expands and contracts with each breath.

Question	Answer		Article
Describe what occurs with a flail chest.	When two or more ribs are broken in two or more places, a section of the chest wall is no longer fixed to the thoracic cavity. This results in paradoxical movement of the flail segment, following the pressure differences between the pleural space and the external environment (inward movement during inspiration; outward movement during expiration).		Link to Article
What would be seen on thoracic radiographs?	Two or more ribs fractured in two or more places. Concurrent injuries such as pneumothorax, pulmonary contusions, or atelectasis of one or more lung lobes may also be seen.		Link to Article
What are indications for stabilization of a flail segment?	Hypoxemia (SpO2 <95%); hypoventilation (PvCO2 >45 mmHg); severe pain; markedly increased effort of breathing; the segment is traumatizing the lung tissue.		Link to Article
What procedures can be done to stabilize a flail chest segment?	Pain relief is essential: systemic opioids and/or local/regional anesthetic rib blocks. Occasionally, a thoracic body bandage (or placing the patient with the affected side down) may be sufficient if external movement of the flail segment is significant and internal movement is minimal. When the flail segment is considered to be interfering with ventilation, surgical options are the preferred method of stabilization and include removal or stabilization of the segment. Non-surgical options may be required for financial reasons and include placing sutures around the broken ribs to an external splint and attaching that splint to a normal portion of the chest wall.		Link to Article

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