Management of flail chest with respiratory failure is: September 2006

Ans. C: IPPV Management of flail chest includes: Good analgesia including intercostal blocks, avoiding narcotic analgesics as much as possible. This allows much better ventilation, with improved tidal volume, and increased blood oxygenation. Positive pressure ventilation (adjusting the ventilator settings, to avoid barotraumas) to 'internally splint' the chest until fibrous union of the broken ribs occur. It is usually reserved for cases developing respiratory failure despite adequate analgesia and oxygen. Chest tubes as required. Adjustment of position to make the patient most comfoable and provide relief of pain. Surgical fixation is usually not required, but may be done in selected patients with isolated or severe chest injury. A patient may be intubated with a double lumen tube. In a double lumen endotracheal tube, each lumen is connected to a different ventilator. Usually one side of the chest is affected more than the other, so each lung may require drastically different pressures and flows to adequately ventilate.