ABSTRACT
In central nervous system (CNS) depressed patients, a sequential approach is necessary to prevent airway obstruction and aspiration of vomitus. Endotracheal intubation is indicated if the lash reflex is absent, response to stimulation is not purposeful, or airway obstruction develops when the patient's neck is flexed. Aspiration may result from CNS depression, abnormal glottic function, or extreme debilitation. It may occur in cannulated patients with improper cuff management or after decannulation while glottic reflexes are ineffective.
Subject(s)
Airway Obstruction/therapy , Central Nervous System/physiology , Adolescent , Adult , Aged , Airway Obstruction/complications , Airway Obstruction/diagnosis , Child , Female , Humans , Infant , Intubation, Intratracheal , Male , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/prevention & controlABSTRACT
Controlled mechanical ventilation has been the mainstay of treatment in the flail chest syndrome for more than 20 years, retrospective studies have recently suggested that the technique is unnecessary, and they infer that spontaneous ventilation or intermittent mandatory ventilation are equally effective. The common theme of these investigations is that mechanical ventilation is required only to relieve hypoxemia associated with the underlying contusion. In two cases of flail chest, spontaneous respiratory efforts resulted in complete disruption of the fracture sites and thus prolonged the duration of mechanical ventilation that was required. In severe cases of flail chest syndrome, there is still a need for controlled mechanical ventilation to splint the rib fractures in a position which facilitates union of the fragments.
