Flail Chest, Ngaahi Motu'a 'o e Rib Lahi, mo e Blunt Chest Trauma 'Uluaki Tokoni¶

'Oku kehekehe 'a e ngaahi fika fakavavevave 'i he fonua .. ʻOku fakaʻaongaʻi ʻe he peesi ko ʻení ʻa e 911, ko e fika ia ki he ʻIunaiteti Siteití mo Kānata. ‘Oku ngāue‘aki ‘e he ngaahi fonua lahi kehe ‘a e 112, 999, pe ko ha toe fika kehe. Kumi e fika ki ho fonua ..

Ko e hui ʻo e tangatá ko ha hui ʻoku ʻelasitiki ʻoku ʻi ai ha ngaahi hoa hui ʻe hongofulu mā ua ʻoku faʻu ke maluʻi ʻaki ʻa e lotó, maʻamaʻá, ngaahi foʻi toto lalahí, ʻaté, mo e ʻutó lolotonga ia ʻene ngāue ko ha foʻi ʻuhila fakamīsini ʻokú ne toho ʻa e ʻeá ki he maʻamaʻá. ‘I he taimi ‘oku taa‘i ai ‘e ha mālohi faka‘au‘auhifo mā‘olunga (hangē ko ha uesia ‘o e steering-wheel, ko ha tō ki ha lue‘anga pe ‘ā, ko ha teke mei ha hoosi, pe ko ha fepakipaki sipoti) ‘i he ‘ā ‘o e fatafatá, ‘e lava ke mafesifesi ha fo‘i hui ‘e taha pe lahi ange. Lolotonga e motu'a 'o e hui faingofua 'e taha 'oku fu'u mamahi 'aupito, motuhi 'a e ua pe lahi ange 'o e hui 'oku fehangahangai 'i he feitu'u 'e ua pe lahi ange (pe detaching 'a e sternum mei he hui 'i he ongo tafa'aki) motuhi ha konga 'o e puipui 'o e fatafata 'oku vetevete kakato mei he toenga 'o e ribcage, 'o fakatupu ha mo'ui-fakatu'utamaki ca**illing chest.f.

'I ha fatafata flail, 'oku 'ikai ke toe toho ki tu'a 'e he ribcage 'a e motu 'oku 'alu holo 'o e ngaahi hui (ko e konga 'o e flail) lolotonga 'a e huhu; ka, 'oku mimisi 'e he vekiume kovi 'i loto 'i he fatafata 'a e konga kuo motu'a ki loto 'i he taimi 'oku manava ai 'a e mahaki, pea 'oku teke ia 'e he 'omi lelei ki tu'a 'i he taimi 'oku manava ai 'a e mahaki (paradoxical chest movement). Na'e toe fakatu'utamaki ange, 'a e uesia fakamālohi 'oku fie ma'u ke snap 'a e ngaahi hui lahi 'i ha ongo feitu'u 'oku ne lavea ma'u pe mo haea 'a e ngaahi kato 'ea microscopic ma'ama'a 'o e ma'ama'a 'i lalo tonu (pulmonary contusion), fakafonu 'a e ma'ama'a 'aki 'a e toto mo e vai 'i he houa 'e 2 ki he 24 hoko mai. ‘Ilo‘i ‘a e ‘uhinga kuo pau ai ke ke ‘oua ‘aupito na‘á ke takai‘i ha tepi fakapipiki pe ngaahi fusi ‘elasitiki fufuu ‘i he fatafatá, founga ke ako‘i ai ‘a e gentle pillow splinting, founga ke fokotu‘u ai ‘a e tokotaha laveá ‘o semi-hangatonu, pea mo e founga ke siofi ai ha ma‘ama‘a ‘oku holo fufuu (pneumothorax 'o e mafasia) pe ko e motuhi ‘o e ‘utó ‘okú ne fakahaofi ‘a e mo‘uí.

Fai ʻeni he taimí ni .¶

Ta ki ho'o fika fakavavevave fakalotofonua 'i he taimi pe ko ia kapau 'oku 'i ai ha ngaue fakafepaki 'a e fatafata 'o e tokotaha 'oku faingata'a'ia (ko ha konga 'o e ngaahi hui 'oku mimisi ki loto 'i he huhu), tolu pe lahi ange 'oku mahalo'i 'oku motu 'a e ngaahi hui, nounou 'a e manava, tale 'o toto, pe mamahi lahi 'i he fatafata hili ha lavea vave 'aupito. Taila 911cross 'i he 'Iunaiteti Siteiti, 'Iulope1 mo Kanata99. Kingdom, 000 ‘i ‘Aositelēlia, pe vakai‘i ‘a e tohi fakahinohino ‘o e . ngaahi fika fakavavevave.
Faka'ali'ali 'a e fatafata 'ata'ataa kotoa pea siofi 'a e ribcage 'oku hake mo hifo 'i he levolo 'o e mata 'i ha sekoni 'e 10 ki he 15. 'Oku 'ikai lava ke ke sio ki ha ngaue fakafepaki 'o fakafou 'i ha kote pe sweatshirt. Sio tangentially ʻi he tafaʻaki ʻo e ʻā ʻo e fatafatá ke ʻiloʻi ha konga ʻoku ngoto ki loto lolotonga e ueʻi fakalaumālié lolotonga ia ʻoku fakalahi ʻa e toenga ʻo e fatafatá.
'OUA 'E TEITEI takai'i fefeka 'a e tepi fakapipiki, ngaahi fusi 'elasitiki, ngaahi fusi, pe ngaahi maea 'o takai 'i he ribcage, pea 'OUA 'E TEITEI fakatoka 'a e ngaahi kato 'one'one mamafa 'i he fatafata. Ko hono ha'i pe tepi'i 'o e circumference 'o e fatafata 'oku ne fakangatangata 'a e fakalahi 'o e mo'ui lelei, 'ikai lavea 'a e ma'ama'a, fakatupu 'a e sa**lapse ma'ama'a (ma'ama'a ma'ulalo ange) ‘okú ne fakavave‘i ‘a e ta‘elavame‘a fakatupu mate ‘i he mānavá.
Poupou'i ha konga flail pe mamahi 'a e motu'a 'o e hui 'o malimali 'aki hono 'ai 'e he mahaki 'ilo'ilo pau ke ne puke ha 'ulumotu'a molumalu, palanikete 'oku fakafonu, pe taueli bulky ki he tafa'aki lavea ("Pillow Splinting"). Poupou nima-puke 'aki ha 'ulumotu'a molumalu dampens mamahi 'o e hui grating mo e manava 'o e restout 'a e tale.
Tuku ha mahaki 'oku 'ilo'i, 'oku ne manava 'o tangutu semi-hangatonu (tu'unga 'o Fowler 'i he 45 ki he 60 tikili) pe ki'i fakapiko ki he tafa'aki lavea (tukukehe kapau 'oku fie ma'u 'e ha lavea 'i he tu'asino ke tokoto 'o 'ata'ata). Nofo semi-hangatonu 'oku ne tuku hifo 'a e ngaahi 'okani 'o e kete 'o mama'o mei he diaphragm 'o e asi; ko hono ki‘i fakapiko ki he tafa‘aki laveá ‘oku ‘ai ai ke fakalahi tau‘atāina ‘a e ma‘ama‘a mo‘ui lelei ‘i ‘olungá.
Monitor 'i he miniti 'e 2 ki he 5 kotoa pe ki he ngaahi faka'ilonga 'o e tupulaki 'a e Tension Pneumothorax, Hemothorax, pe Spleen/Liver Rupture. Ko e ngaahi ngata'anga 'o e hui 'oku motu'a 'oku 'i ai 'a e hele-masila pea 'oku fa'a puncture 'a e ma'ama'a 'i lalo (fakatupu 'a e fakalakalaka 'o e tauhele 'o e 'ea mo e bulging 'o e ngaahi veini 'o e kia) pe ribender pe1 'ate ('i lalo 'i he ngaahi hui to'omata'u 7 ki he 11). Tauhi 'a e mahaki ke mafana pea NPO fefeka ('ikai ha me'a 'i he ngutu).

Ko e hā ʻoku tapui ai ʻa e tōʻonga motuʻa ʻo hono tepiʻi ʻo e ngaahi hui kuo motú pe ʻai ha ngaahi kato ʻoneʻone ʻi ha fatafata flail .

ʻI ha ngaahi hongofuluʻi taʻu lahi, naʻe akoʻi ai ʻe he ngaahi tohi tokoni ʻuluaki motuʻá ʻa e kau fakahaofi moʻuí ke nau takaiʻi fefeka ha ngaahi foʻi tepi fakapipiki ʻoku fālahi ʻi he fatafatá ki he ngaahi hui kuo motuʻá, pe ke fokotuʻu ha kato ʻoneʻone mamafa ʻi ʻolunga ʻi ha konga fatafata flail ke taʻofi ia mei heʻene ngaʻunu ki lotó. Kuo li'aki faka'aufuli 'e he faito'o fakaonopooni ki he lavea (ATLS, PHTLS, Kolosi Kulokula 'Amelika, UK NHS/NICE) 'a e ongo founga fakatou'osi. Ko e hā hono ʻuhingá? He ko e tefito'i fakapoongi 'i he fatafata flail 'oku 'ikai ko e wobbling fakamisini 'o e ngaahi hui kuo motu'a 'iate kinautolu pe, ka ko e 'i lalo 'oku lavea, fonu 'a e ma'ama'a 'i he vai (pulmonary contusion) mo e atelectasis (holo 'a e ngaahi kato 'ea mei he manava 'oku 'ikai loloto). Ko hono tepi‘i ‘a e ‘ā ‘o e fatafatá pe fakamamafa‘i ia ‘aki ha kato ‘one‘one ‘okú ne motuhia ai ‘a e malava ‘a e mānava ‘a e mahakí ‘aki ‘a e peseti ‘e 30 ki he 50, ‘o ta‘ofi ai kinautolu mei hono fakama‘a ‘a e mucus, pea fakamālohi‘i kinautolu ke nau vave ‘o puke ‘a e mānava ‘oku ‘ikai ke ‘i ai ha ‘oksikisi. Fakaʻaongaʻi pē ʻa e splinting ʻo e ʻuluʻulu ʻoku puke ʻe he nimá ʻoku anga-malū, loto-fiemālie mo e tuʻunga hangatonu.

'Akau tu'utu'uni fakavavevave ki he lavea 'i he fatafata mo e ngaahi motu'a 'o e hui¶

flowchart TD
    Start["Blunt Impact to the Chest Wall, Ribcage, or Breastbone (Sternum)"]
    Expose["Expose Entire Bare Chest and Look Across Ribcage at Eye Level<br/>Assess breathing rate, depth, skin color, and symmetry"]
    FlailCheck{"Is Paradoxical Chest Movement Present?<br/>(A section of ribs sucks INWARD during inhalation<br/>and bulges OUTWARD during exhalation)"}
    FlailProtocol["FLAIL CHEST & PULMONARY CONTUSION PROTOCOL<br/>1. Call EMS (911 / 112 / 999) immediately for ALS trauma transport<br/>2. DO NOT tape ribs; DO NOT place heavy weights/sandbags on chest<br/>3. Have conscious patient hold a soft pillow or folded blanket gently over flail area<br/>4. Sit patient semi-upright (45 deg) or tilted slightly toward injured side<br/>5. If breathing becomes shallow/failing, assist with gentle positive-pressure breaths"]
    RedFlagRibs{"Are ANY High-Risk Rib Fracture Red Flags Present?<br/>- Shortness of breath, blue lips, or SpO2 < 94%<br/>- Coughing up bright red or frothy pink blood (hemoptysis)<br/>- Subcutaneous emphysema ('Rice Krispies' crackles under skin)<br/>- Fractures of Upper Ribs (1-2), Lower Ribs (9-12), or Sternum<br/>- Patient is > 65 years old, frail, on blood thinners, or has COPD<br/>- 3 or more painful ribs"}
    UrgentEMS["HIGH-RISK BLUNT THORACIC TRAUMA<br/>1. Call EMS (911 / 112 / 999) or go to Emergency Department immediately<br/>2. Sit semi-upright; support ribs with soft pillow when coughing<br/>3. Monitor closely for Tension Pneumothorax or Spleen/Liver bleeding<br/>4. Keep patient strictly NPO (nothing by mouth) and warm"]
    SimpleRib["SUSPECTED SIMPLE ISOLATED RIB FRACTURE OR CHEST WALL BRUISE<br/>(Young healthy adult, low-energy bump, normal breathing, no red flags)<br/>1.Seek medical evaluation to rule out small pneumothorax and get pain plan<br/>2. NEVER wrap or tape the chest<br/>3. Perform 'Pillow-Splinted Deep Breaths & Coughs' every hour while awake<br/>   to prevent post-injury pneumonia"]

    Start --> Expose
    Expose --> FlailCheck
    FlailCheck -->|Yes: Paradoxical Movement| FlailProtocol
    FlailCheck -->|No: Chest Moves Outward Together| RedFlagRibs
    RedFlagRibs -->|Yes: Any Red Flag Present| UrgentEMS
    RedFlagRibs -->|No: Isolated Point Tenderness Only| SimpleRib

Ngaahi sone fakatu'utamaki faka'anatomi 'o e ribcage: Ko e fē 'a e ngaahi hui kuo motu'a 'oku fakamanamana'i 'a e ngaahi 'okani 'i loto .¶

ʻOku ʻikai ke ʻave ʻe he ngaahi hoa hui ʻe hongofulu mā uá kotoa ʻa e fakatuʻutāmaki tatau. ‘Oku vahevahe ‘e he kau toketaá ‘a e hui-tu‘á ki ha ngaahi sone faka‘anatomi kehekehe ‘e fā koe‘uhi ko e feitu‘u ‘oku motu ai ‘a e hui-tu‘á ‘okú ne tomu‘a tala ‘a e lavea ‘o e ‘ōkani ‘i loto ‘oku fufuu‘i ‘i laló:

Sone Ribcage	Ngaahi Hui Pau ‘Oku Kau ki Aí .	Ngaahi 'ulungaanga faka'anatomi & Paiomekanikale	Lavea Fakapulipuli Tefito 'i Loto ki he Mahalo'i
Sone 'o e fatafata 'i 'olunga	Ngaahi Hui 1, 2, mo e 3, Kalavikula, mo e Skapula (Uma)	Nounou, matolu, malu'i lahi 'i lalo 'i he hui 'o e 'uhiki, 'o e uma, mo e matolu 'o e pectoral/kia 'o e ngaahi uoua. Fiema'u 'a e ivi kinetic lahi ke motuhi	Subclavian Artery pe Vein lo'imata, Brachial Plexus lavea, 'akau 'o e Tracheobronchial, pe Lavea 'o e Aortic Fakamamahi (fakahisitolia 'o a'u ki he 30% 'o e mate mei he lavea 'o e vaka lahi/'ulu 'oku fekau'aki mo ia)
Sone Thoracic Lotolotó (Lahi taha hono motuhia)	Ngaahi hui 4 ki he 9 (tautautefito ki he tafa'aki 'o e mid-axillary curve 'a ia 'oku pikopiko māsila taha ai 'a e hui)	Ko e ngaahi hui lōloa, manifinifi, mo fakahaaʻi. Ko e ngaahi mālohi mei tu‘á ‘oku nau punou‘i ‘a e hui-tu‘á ki tu‘a kae ‘oua kuó ne tō ‘i he tuliki tafa‘akí (teke‘i ‘a e ngaahi ngata‘anga ‘o e huí ki tu‘a) lolotonga ia ‘oku tō ‘a e hui-tu‘á ki loto .	Faingofua pe . Niumotholakisi 'o e mafasia ('oku punctures 'e he ngata'anga 'o e hui māsila 'a e pleura/ma'ama'a), Hemothorax (haea 'o e 'alati intercostal 'oku lele 'i he 'aofi 'i lalo 'o e hui takitaha), mo e Ko e lavea 'o e ma'ama'a / Flail Chest
Sone 'o e fatafata 'i lalo	Ngaahi hui 9, 10, 11, mo e 12 (kau ai 'a e "ngaahi hui 'oku 'alu holo" 11 mo e 12 'oku 'ikai ke fakapipiki 'i mu'a)	Fakahangatonu 'a e 'okani fefeka 'i 'olunga 'o e kete tucked 'i lalo 'i he dome 'o e diaphragm .	Ngaahi Hui Lalo To'omata'u (8-12): Laceration 'o e 'ate ('oku hoko 'i he -10% ki he 15% 'o e ngaahi keisi). To'ohema 'o e ngaahi hui 'i lalo (9-12): Spleen rupture ('oku hoko 'i he -20% 'o e ngaahi keisi; vakai ki he faka'ilonga 'o Kehr = 'oku 'uhinga ki he mamahi 'o e tumu'aki 'o e uma to'ohema mo e hemorrhagic 'ohovale)
Sone 'o e Mu'a & Kostokoni	Sternum (Hu'i-fatafata) mo e Ngaahi hui-hu'a 'o e Costochondral 'oku ne fakafehokotaki 'a e ngaahi hui ki he fatafata	Fakahangatonu ‘a e steering-wheel, airbag, pe CPR compression sone ‘i mu‘a fakahangatonu ‘i he ventricle to‘omata‘u ‘o e lotó .	Lavea 'o e Loto (Lavea 'o e Loto) 'o fakatupu 'a e 'ikai ke ngaue 'a e mafu pe ko e 'ohovale 'a e loto, Anterior Flail Sternum, pe ko e tafe toto 'i he 'alati 'o e mammary 'i loto

Ko e 'anatomi mo e pathophysiology 'o e fatafata 'o e Flail mo e lavea 'o e ma'ama'a¶

1. Founga 'oku fa'u ai ha Vahe Flail pea mo e 'uhinga 'oku ne nga'unu ai ki mui (Nga'unu Fakafepaki)¶

Ko ha fatafata flail 'oku fie ma'u ke 'oua 'e si'i hifo 'i he ** ua 'o e ngaahi hui 'oku fehangahangai 'oku motuhi 'i ha feitu'u 'e ua pe lahi ange** 'i he tafa'aki tatau (pe ngaahi mavahevahe costochondral bilateral detaching 'a e sternum). 'Oku fakatupu 'e he me'a ni ha panel tau'ataina-'oku 'alu holo 'o e puipui 'o e fatafata kuo mole 'a hono hokohoko 'o e hui mo e toenga 'o e fale 'o e fatafata: * Lolotonga 'a e Inhalation Angamaheni: 'Oku fakasi'isi'i 'a e diaphragm ki lalo pea 'oku toho 'e he ngaahi uoua intercostal 'i tu'a 'a e ribcage 'oku kei hao ki 'olunga mo tu'a. 'Oku fakahifo 'e he me'a ni 'a e 'omi 'i loto 'i he ava 'o e fatafata 'i lalo 'i tu'a 'a e 'ea 'o e 'ea (ki he fakafuofua ki he -8 \(\text{cmH}_2\text{O}\)). Koe'uhi ko e konga flail 'oku 'alu holo 'oku mavahe ia mei he ribcage fefeka, 'oku teke ia 'e he 'ea 'i tu'a INWARD ki he ava 'o e fatafata 'o e negative-pressure lolotonga ia 'oku fakalahi 'a e toenga 'o e ribcage ki tu'a. * Lolotonga 'a e Exhalation (pe Tale): 'Oku hiki hake 'a e 'omi 'i loto 'i he fatafata 'o mahulu hake 'i he 'ea, 'o teke 'a e konga 'o e flail 'oku 'alu holo OUTWARD lolotonga ia 'oku ngoto 'a e toenga 'o e ribcage ki loto. * Ko e hā ʻoku faʻa mole ai ʻa e Paradoxical Motion lolotonga ʻa e ʻuluaki miniti ʻe 30 ("Ko e Mask ʻo e uoua-Spasm"): Hili pē ha fakatuʻutāmaki, ʻoku ʻalu ha ʻiloʻilo pau, uoua ʻo e mahaki intercostal mo e ngaahi uoua ʻo e puipui ʻo e fatafatá ki he riward taʻefakakaukauʻi lahi ** leʻohi ʻo e spasm ** ʻi he tafaʻaki ʻo e ngaahi hui ʻoku motuʻá ʻo ʻikai ke ke temporail ngoto ‘i he ‘uluaki taimí. Pea, hili ha miniti ʻe 20 ki he 60, ʻi he vaivai ʻa e ngaahi uoua intercostal mei he vaivai mo e hypoxia, ʻoku ʻoatu ʻe he splint ʻo e uoua pea ʻoku fakafokifā pē ʻa e ʻasi mai ʻa e ngaue fakafepaki fakaofo. Toe vakaiʻi maʻu pē ʻa e fatafata ʻataʻatā ʻi he miniti ʻe 5 ki he 10 kotoa pē.

2. Ko e ha 'oku hoko ai 'a e Ma'ama'a (Bruised Lung) ko e fakapoongi mo'oni 'i he Flail Chest .¶

Na‘e tui ‘a e kau toketā ‘i he kamata‘anga ‘o e senituli hono 20 ‘oku tāmate‘i ‘e he fatafata ‘o e flail ‘a e kau mahakí koe‘uhi na‘e ‘alu holo ‘a e ‘eá ‘i he vaha‘a ‘o e ongo ma‘ama‘á (Pendelluft). Na'e fakamo'oni'i 'e he fakatotolo fakafisiolosia fakaonopooni ko e pathology mo'oni 'oku fakatu'utamaki ki he mo'ui 'i he fatafata flail ko e Pulmonary Contusion 'i lalo fakataha mo e mamahi 'i he puipui 'o e fatafata mo e ta'elavame'a 'o e bellows fakamisini: 1. Alveolar Hemorrhage mo e Edema: Ko e uesia lahi 'o e blunt 'oku ne snaps 'a e ngaahi hui lahi 'i he ongo feitu'u 'oku ne 'ave ha shockwave 'o fakafou 'i he tisiuu 'o e ma'ama'a hange ha sponge 'i lalo hangatonu. ‘Oku movete ‘a e ngaahi fo‘i huhu‘a si‘isi‘í mo e ngaahi ‘ā ‘o e ‘alveolá, ‘o fakafonu ‘a e ngaahi kato ‘eá ‘aki ‘a e toto, vai ‘oku lahi ai ‘a e polotiní, mo e ngaahi veve ‘oku fakatupu vela. 2. Ko e Pomu Taimi "Blossoming" Toloi (Houa 'e 2 ki he 24): Ko e lavea 'i he ma'ama'a 'oku ne 'ulungaanga 'o hange pe ko ha lavea lahi 'i ho kili: 'oku 'ikai ke ne fula ki hono lahi kakato 'i he 'uluaki miniti 'e 5. Ko ha mahaki 'oku 'i ai ha fatafata flail pe ko ha puhi 'o e fatafata blunt lahi 'e lava ke ma'u 'e he ofi-angamaheni 'a e ngaahi tu'unga 'o e 'osikena 'i he hili pe 'a e fakatu'utamaki, ka 'i he houa 'e 2 ki he 24 hoko mai, 'oku tafe ma'u pe 'a e vai interstitial mo e toto 'i he alveoli 'o e ma'ama'a kuo lavea ("blossoming 'o e contusion"). ‘Oku ‘ikai lava ‘e he ‘osikena ke kolosi ‘i he ngaahi kato ‘ea ‘oku tafea ki he toto (intrapulmonary shunting), ‘o fakatupu ai ‘a e fakalakalaka, hypoxia lahi mo e mahaki faka‘auha ‘o e mānava (ARDS). 3. Fakatokanga Fakafaito'o 'o e Fānau (Pulmonary Contusion 'O 'IKAI HA Motu'a 'o e Hui): 'I he fanga ki'i pēpē, fānau, mo e to'utupu, 'oku fa'u 'a e ngaahi hui 'aki 'a e 'elasitiki lahi, uncalcified cartilage mo e hui pliable. Ko ha ki'i tamasi'i 'oku taa'i 'e ha me'alele pe lī mei ha pasikala 'e lava ke ne mamahi'ia 'i ha fu'u, fakatu'utamaki ki he mo'ui 'a e pulmonary contusion, pneumothorax, pe lavea 'a e loto 'o 'ikai ke motuhi ha hui 'e taha, koe'uhi ko honau ribcage 'oku fe'unga 'oku piko 'a e founga kotoa pe ki loto ke holoki 'a e shape pea toki puna totonu 'o foki ki tu'a ki he i. ‘Oua ‘aupito ‘e faka‘ikai‘i ‘a e lavea lahi ‘i loto ‘i he ma‘ama‘á ‘i ha ki‘i tama koe‘uhi pē ko e hā ngali kei hao honau ngaahi hui-tu‘á.

Tokoni 'uluaki fakasitepu ki he Flail Chest mo e ngaahi motu'a lahi 'o e hui¶

Sitepu 1: Fakahaaʻi, sio, mo ongoʻi māmālie ʻa e ʻā ʻo e fatafatá .¶

ʻAi ke tangutu pe mālōlō fiemālie ʻa e mahakí pea toʻo pe motuhi ʻa e kofu ʻi ʻolungá ke ʻasi kotoa ʻa e fatafatá.
Sio ki he levolo 'o e mata: Tu'ulutui 'i he tafa'aki 'o e mahaki pea sio 'i he tafa'aki 'o e palani fakahosite 'o honau fatafata 'i ha sekoni 'e 15 ke vakai'i pe 'oku 'alu hake tatau 'a e ongo tafa'aki pea pe 'oku ngoto ha konga ki loto 'i he taimi 'oku huhu ai.
Ongo'i malimali ki he Subcutaneous Emphysema mo e Crepitus: 'I he ngaahi louhi'i nima 'oku 'i ai 'a e to'ukupu 'oku palapala, ala ma'ama'a ki he kili 'o takatakai 'i he ngaahi hui 'o e 'uhiki, kia, mo e feitu'u 'o e hui 'oku lavea:
Bony Crepitus: Ko ha ongo grating crunchy 'o e ngaahi ngata'anga 'o e hui motu'a 'oku milimili fakataha ('ikai 'oua lomi'i fefeka 'i he taimi 'oku ongo'i ai).
Emphysema 'i lalo 'i he kili: Ko ha ongo 'oku ngingila hange ko e popping 'a e ki'i Bubble Wrap pe ko e Rice Krispies cereal 'i lalo tonu 'i he kili. Ko e emphysema 'i lalo 'i he kili ko ha fuka kulokula mahu'inga: 'oku ne fakamo'oni'i kuo punctured 'e ha hui motu'a māsila 'a e parietal pleura mo e tisiuu 'o e ma'ama'a 'i lalo, 'o fakamālohi'i 'a e 'ea mei he ma'ama'a ki he la'i ngako 'i lalo 'i he kili, pea fakatokanga mai 'oku 'i ai ha pneumothorax pe pneumothorax 'o e mafasia 'oku 'i ai 'a e hui 'o e mafasia** 'oku 'i ai.

Sitepu 2: Faka'aonga'i 'a e "Pillow Splinting" Malimali ('Oua 'aupito na'a tepi pe 'one'one)¶

To'o ha 'ulumotu'a mohenga molumalu, ha palanikete fulufulu'isipi kuo fakafonu matolu, ha kote kuo fakafonu, pe ko ha taueli kaukau lahi pea fokotu'u malimali ia 'i he konga 'o e flail pe ko e ngaahi hui kuo motu'a.
Kapau 'oku 'ilo'i mo tokanga 'a e mahaki: 'Ai ke puke malie 'e he mahaki 'a e 'ulumotu'a molumalu ki honau ngaahi hui kuo lavea 'aki hono nima mo hono nima 'o'ona. ‘Oku nau lava fakanatula ‘o fakatonutonu ‘a e poupou anga-malū ki lotó ke fakasi‘isi‘i ‘a e ngaue mamahi ‘a e hui-tu‘á ‘i he taimi ‘oku nau mānava ai pe tale ‘o ‘ikai fakangatangata honau ma‘ama‘a leleí.
Kapau kuo pau ke ke fakatau'ataina'i 'a e nima 'o e mahaki lolotonga 'a e fefononga'aki: 'E lava ke ke ngaue'aki ha sling fusi tapatolu 'oku laulahi mo ha loose swathe 'oku ne pukepuke 'a e nima pikopiko 'o e mahaki tonu mo ha pad molumalu ki he tafa'aki lavea 'o e fatafata, 'oua 'aupito na'a toho fefeka fe'unga ke compress 'a e ribcage pe fakangatangata 'a e uninjured.

Sitepu 3: Tuʻunga Lelei Taha ki he Mānavá¶

Mahaki 'oku 'ilo'i 'o 'IKAI mahalo'i 'oku lavea 'a e tu'asino:
Fakanofo 'a e mahaki 'i he tu'unga semi-Fowler pe tu'u hangatonu (tikilī 'e 45 ki he 60), 'o ki'i punou ki he tafa'aki lavea 'o poupou'i 'e he ngaahi 'ulumotu'a.
Ko e hā ke kiʻi fakapikopiko ai ki he tafaʻaki laveá? Ko e ki'i fakafalala ki ha 'ulumotu'a molumalu 'i he tafa'aki kuo motu'a 'oku ne ngaue'aki 'a e mamafa 'o e sino malimali ke fakatu'uma'u 'a e ngaahi hui 'o e flail lolotonga ia 'oku faka'ata 'a e ma'ama'a 'oku 'ikai lavea 'i he tafa'aki ma'olunga ange ke fakalahi ki hono voliume lahi taha 'o 'ikai ha fakangatangata.
Mahaki 'oku mahalo'i 'oku ne kia pe tu'a (tuʻasino) lavea:
Tauhi ʻa e tuʻasinó ʻi ha tuʻunga tuʻu-ʻataʻatā ʻi he laine ʻi ha funga ʻoku palakū pe ko ha meʻa-fakaʻuli ʻo e scoop, ʻai ha taueli pe ʻulumotuʻa kuo fakafonu molū ʻi he konga ʻo e flail (ʻoku pukepuke maʻamaʻa ʻe ha nima ʻo ha tokotaha fakahaofi moʻui ʻo ʻikai teke hifo), pea siofi maʻu pē ʻa e mānavá.
Mahaki manava ta'e'ilo ('Ikai ha lavea 'i he tu'asino):
Tuku 'i he tu'unga fakaakeake lateral mo e tafa'aki LAVEA 'I LALO 'o fakafepaki'i 'a e kelekele/padding pea mo e Ma'ama'a MO'UI KI 'OLUNGA koe'uhi ke lava 'o fakalahi tau'ataina 'a e ma'ama'a lelei 'o 'ikai ke laiki 'e he mamafa 'o e sino.

Sitepu 4: Fēfē kapau ʻoku ʻikai toe mānava feʻunga ha taha mahaki ʻoku ʻi ai ʻene Flail Chest? (Fakatu'uma'u 'o e Pneumatic 'i loto)¶

Koe'uhi ko hono hiki 'o ha fatafata flail 'oku fie ma'u 'a e feinga lahi 'o e uoua pea 'oku 'ikai lava 'e he ma'ama'a 'o e lavea 'i lalo ke absorb lelei 'a e 'osikena, 'e lava ke vave 'a e vaivai 'a e kau lavea mo e ngaahi konga flail lalahi: 'oku hoko 'enau manava 'o vave mo 'ikai loloto (> 30 breaths/min) pea toki fakatu'utamaki 'a e tuai (< 8 ki he.
Founga 'oku ngaue ai 'a e ngaahi manava fakahaofi 'o e lelei-'o e 'omi ko ha "Splint 'i loto": 'Oku kehe mei he manava 'o e angamaheni 'o e 'omi ('a ia 'oku fakafalala ki he 'omi 'o e vekiume kovi 'oku ne mimisi 'a e konga flail * ki loto *), malimali 'a e 'ea 'o e lelei-'o e 'ea ('o fakafou 'i ha me'a fakapuli 'o e kato, kato-valve)w breathr 'i he lalo 'o e 'omi 'o e lelei, 'a ia 'oku ne teke 'a e konga 'o e flail 'oku 'alu ki tu'a 'i he tafa'aki tatau mo e toenga 'o e ribcage ("fakatu'uma'u pneumatic 'i loto").
Tokanga Mahu'inga mo e Positive-Pressure Breaths 'i he Lavea 'o e Fafatafata: Koe'uhi kuo fa'a punctured 'e ha hui 'oku motu 'a e ma'ama'a 'i lalo, 'e lava ke fakamālohi'i 'e he puhi'i 'o e manava fakatupu 'ita, ma'olunga-volume ki he ma'ama'a 'a e 'ea ki tu'a 'o fakafou 'i he lo'imata 'o e ma'ama'a ki he ava 'o e fatafata, vave hono fakatupu ha x tension pneumotho. Fakahoko 'a e ngaahi manava fakahaofi malimali, mamalie, pea fe'unga pe ke sio ki he 'alu hake 'a e fatafata angamaheni.

Pule'i 'o e ngaahi motu'a 'o e hui faingofua: Ko e ha 'oku fehangahangai ai 'a e kakai lalahi matu'otu'a mo e Niumonia mo e Founga 'oku Fakahaofi ai 'e he "Splinted Coughing" 'a e Mo'ui¶

Lolotonga e kau sipoti kei talavou ‘oku ‘i ai ‘enau hui ‘e taha ‘oku mafesifesi ‘oku nau meimei ke nau mo’ui lelei ma’u pe, ko e motu’a ‘o e hui ‘i he kakai lalahi matu’otu’a (ta’u 65 ki ‘olunga) pe ko e kau mahaki ‘oku nau ma’u ‘a e mahaki ma’ama’a (COPD) ko ha fakatu’utamaki lahi ia ki he mo’ui: * ‘Oku fakahaa‘i ‘e he ngaahi lēsisita ‘o e ngaahi lavea fakafaito‘ó ‘i he toe motu‘a kotoa pē ‘o e hui ‘i ha mahaki ‘oku laka hake ‘i he ta‘u 65, ‘oku tupulaki ‘a e fakatu‘utāmaki ‘o e ma‘u ‘e he niumonia pekitiliá ‘aki ‘a e peseti ‘e 27, pea ‘oku tupulaki ‘a e maté ‘aki ‘a e peseti ‘e 19.

Ko e Siakale Kovi 'o e Mamahi 'o e Hui -> Atelekitasi -> Niumonia¶

Ko e hā ʻoku fakatupu ai ʻe ha foʻi hui mafesifesi faingofua ha niumonia fakatupu mate hili ha ʻaho ʻe 3 ki he 5 mei ai? 1. Ko hono mānava loloto angamaheni pe tale ‘okú ne fakaloloa ‘a e ngaahi uoua ‘i he vaha‘a ‘o e ongo umá pea milimili fakataha ‘a e ngaahi ngata‘anga ‘o e hui kuo motú, ‘o fakatupunga ai ha mamahi ‘oku tuki. 2. Ke faka'ehi'ehi mei he mamahi māsila ko ia, 'oku to'o 'e he mahaki 'a e fanga ki'i mānava iiki mo loloto (hypoventilation / splinting) pea fakafisi ke tale. 3. Ka ʻikai ha ngaahi mapuhoi loloto mo e tale fakataimi, ʻoku holo ʻa e fanga kiʻi kato ʻea ʻi he lalo maʻamaʻá ʻi he tafaʻaki laveá ʻo hangē ha ngaahi foʻi pulu kuo ʻosi fakaʻauʻauhifó (atelectasis) pea fonu ʻi he ʻuʻulu ʻoku ʻikai ke ʻi ai ha ʻea. 4. ‘Oku tokolahi ‘a e fanga ki‘i pekitiliá ‘i loto ‘i he vai māfana ko ia ‘o e mucus kuo ma‘ú, ‘o fakatupu ai ‘a e niumonia lobar post-traumatic lahi mo e ta‘elavame‘a ‘i he mānavá ‘i loto ‘i he houa ‘e 48 ki he 96.

Founga ke maumau'i 'a e siakale: Multimodal Analgesia mo e Houa "Tale 'o e 'ulumotu'a-Splinted".¶

Hili hono siviʻi ʻe ha toketā ʻa e mahakí (pea fakaʻikaiʻi ha pneumothorax pe toto ʻi loto): 1. 'Oua 'aupito na'a ke takai pe ha'i 'a e fatafata: Li'aki 'a e ngaahi fusi hui motu'a pe ngaahi takai fatafata 'elasitiki. 2. Fakahoko 'a e "Manava loloto 'o e Pillow-Splinted mo e tale Huff" 'i he houa 'e 1 ki he 2 kotoa pe lolotonga 'a e 'ā: * ʻAi ke tangutu hangatonu ʻa e mahakí ʻi ha sea pea ʻuma lelei ki ha ʻuluʻulu mohenga fefeka ʻi he ngaahi hui mamahí ʻaki hono ongo nimá fakatouʻosi. * Lolotonga hono lomiʻi māmālie ʻo e ʻulumotuʻá ki loto ki he hui mamahí ke fakatuʻumaʻuʻi ia, toʻo ʻa e 5 ki he 10 mānava māmālie, loloto ʻi he founga kotoa pē ki loto, pukepuke ʻa e mānava takitaha ʻi ha sekoni ʻe 3 ʻi ʻolunga ke pop fakaava ʻa e ngaahi kato ʻea kuo holo (ʻo fakaʻaongaʻi ha spirometer fakalotolahi kapau ʻoku ʻoatu ʻe he falemahakí). * Muimui 'aki 'a e 2 malimali, poupou'i 'e he 'ulumotu'a "huff coughs" ke fakama'a ha phlegm mei he ma'ama'a 'i lalo. 3. Muimui ki he palani kuo fakataimitēpileʻi ʻe he toketaá ki hono mapuleʻi ʻo e mamahí: ʻOku ʻikai ke hangē ia ko e ngaahi kafo ʻi he hui ʻa ia ʻoku ʻuhinga pē ʻa e faitoʻo ki he mamahí ki he fakafiemālié, ko e fakanonga feʻunga ʻo e mamahí ʻi he ngaahi motuʻa ʻo e hui ko ha faitoʻo fakafaitoʻo fakahaofi moʻui koeʻuhí he ʻokú ne fakaʻatā ʻa e mahakí ke ne mānava loloto mo tale. 'I he ngaahi falemahaki, 'oku fa'a ma'u 'e he kau mahaki 'oku lahi 'a e ngaahi hui 'oku motu'a 'a e ngaahi poloka neave fakavahefonua 'oku fakataumu'a (hange ko ha ** poloka 'o e vakapuna 'i mu'a 'o e serratus, poloka 'o e erector spinae, pe thoracic epidural **) koe'uhi ke nau lava 'o manava loloto 'o 'ikai ha fakanonga 'o e opioid. 4. Faka'aonga'i 'a e ngaahi 'aisi 'oku takai 'i ha taueli 'i ha miniti 'e 15 ki he 20 'i he taimi 'i he funga 'o e 'uhiki'i 'akau 'i he 'uluaki houa 'e 48 ke fakasi'isi'i 'a e fula 'o e periosteal fakalotofonua.

Ko e ngaahi lavea kehe 'o e fatafata blunt fakatupu mate ke 'ilo'i 'i he mala'e .¶

ʻI he taimi ʻoku taaʻi ai ʻe ha mālohi vave ʻo e blunt ʻa e ʻā ʻo e fatafatá pe sternum, ʻe lava ke hoko ha ngaahi meʻa fakatuʻupakē ʻe tolu ʻoku fufuuʻi ʻi he lotó mo e vascular ʻi he tafaʻaki ʻo e ngaahi motuʻa ʻo e hui:

1. Commotio Cordis (Fakafokifā ʻa e Puke ʻo e ʻUlu ʻo e ʻUlu ʻo e Uesia)¶

Commotio cordis ko ha puke fakafokifā, fakatupu mate 'o e loto 'oku fakatupu 'e ha puhi māsila, 'oku 'ikai fu'u lahi hono ivi 'o fakahangatonu 'i he 'ā 'o e fatafata to'ohema ('i he funga tonu 'o e siluetā 'o e loto) 'i he taimi 'oku 'ikai ai ha maumau fakafa'unga ki he ngaahi hui pe uoua 'o e loto 'i ha me'a. * Typical Scenario: Ko ha ki'i tamasi'i, to'utupu, pe tokotaha lahi kei talavou 'i he vaha'a 'o e ta'u 5 mo e 25 'oku taa'i fakatafa'aki ia 'i he fatafata to'ohema 'e ha me'afana fefeka (ko ha peisipolo, polo lakolosi, fo'i 'akapulu, polo kilikiti, 'aka fakakautau, pe tuliki). ‘E lava ke fai ‘e he tokotaha sipotí ha sitepu tūkia ‘e taha pe ua pea tō leva ‘o ‘ikai ke ne tali ‘aupito, ‘ikai ke ne lava ‘o mānava, pea ‘ikai ke ne lava ‘o puna. * Ko e founga 'o e 'uhila: Kapau 'oku taa'i 'e he projectile 'a e puipui 'o e fatafata lolotonga ha ultra-fakapuliki 15-ki he-30-milisekoni 'o e matapa sio'ata 'i he upslope 'o e T-peau ('i he taimi 'oku repolarizing ai 'a e ngaahi ventricles 'o e loto mo e 'uhila 'oku faingata'a'ia 'a e 'ohovale 'i he channelwa 'o e 'uhila). 'oku ne fakatupu 'a e vave 'o e Fibrillation 'o e loto (VF) 'o e puke 'o e loto. * Tokoni Fakavavevave: 'Oku lau 'a e sekoni kotoa pe. Kamata 'a e ngaahi fakamalohi'i 'o e fatafata 'oku tu'unga ma'olunga (CPR) he taimi pe ko ia pea fakapipiki ha Automated External Defibrillator (AED) ‘i loto ‘i he miniti ‘e 3. Ko e mo’ui mei he commotio cordis ‘oku laka hake ia ‘i he peseti ‘e 70** kapau ‘e fakahoko ‘a e CPR mo ha ‘oho ‘a e AED ‘i loto ‘i he miniti ‘e 3, ka ‘oku holo hifo ia ki lalo ‘i he peseti ‘e 10 kapau ‘e toloi ‘o laka hake ‘i he miniti ‘e 5.

2. Lavea ‘a e Lotó (Myocardial Contusion) mo e Ngaahi Motu‘a ‘o e Sternal¶

Ko e taimi 'oku 'oho ai 'a e hui fatafata (sternum) 'o ha faka'uli ki ha steering wheel pe seatbelt fufuu 'i he vave 'o e hala lahi, 'oku holoki 'a e ventricle to'omata'u 'o e loto ('a ia 'oku tangutu 'i mui tonu 'i he sternum) 'i he vaha'a 'o e hui fatafata 'i mu'a mo e thoracic spine 'i mui. * Ngaahi Faka'ilonga Fakatokanga: Ko e mamahi 'o e fatafata 'i he lotolotonga 'oku 'ikai ke fakanonga 'e he malolo, ko ha lavea pe laka-me'a 'i he lotolotonga 'o e hui 'o e fatafata (motu'a 'o e fatafata), ko ha ta'efakalao, puna, pe lele 'a e pulse (sinus tachycardia, vave 'a e ngaahi faka'auha 'o e ventricular, pe atrial unebloodplaxd), and 'ohovale**). * Tokoni 'Uluaki: Tauhi 'a e mahaki ke tangutu fakalongolongo semi-hangatonu, ta'ofi ha fa'ahinga ngaue fakasino, siofi 'a e pulse hokohoko ki he puke fakafokifā 'o e loto, pea fokotu'utu'u 'a e fefononga'aki vave 'o e me'alele fakahaofi mo'ui ALS ki he 12-taki ECG siofi mo e sivi 'o e troponin 'o e loto.

3. Lavea Fakatu'utamaki 'o e Aortic (Lo'imata Fakatuai)¶

'I ha fakatu'utamaki 'o e me'alele 'i he > 60 km/h (40 mph) pe ko ha hinga mei he > mita 'e 6 (fute 'e 20), 'oku ta'alo ki mu'a 'a e 'aofi fe'ave'aki 'o e aorta lolotonga ia 'oku kei ha'i fefeka 'a e aorta 'o e fatafata 'oku hifo ki he tu'asino 'e he ligamentum arteriosum 'o e aortall, 'o haea 'a e aortall. Lolotonga e peseti 'e 80 'o e ngaahi movete kakato 'o e aorta 'oku fakatupu mate 'i he feitu'u, peseti 'e 20 'o e kau mahaki 'oku nau mo'ui 'i he kamata'anga koe'uhi ko e sheath fefeka 'i tu'a 'o e aorta (ko e adventitia) 'oku ne pukepuke fakataimi 'a e toto 'i loto 'o hange ha fo'i 'uto 'oku 'i ai (ko ha pseudoaneurysm 'oku 'i ai). * Tauhi ha taha pē ʻoku maʻukovia ʻi he fakatuʻutāmaki ʻo e deceleration vave ke nonga ʻaupito mo kei nofo pē lolotonga ʻa e fefonongaʻakí; ko e manavasi‘i fakafokifā, faingata‘a‘ia, pe mamahi ‘okú ne fakatupulekina ‘a e toto mā‘olungá pea ‘e lava ke ne pa ‘a e lo‘imata ‘o e ‘aoti ‘oku ‘i aí ki mu‘a ke toki fakalelei‘i ‘a e tafa stent-graft.

Lisi Sivi ʻo e Tuʻuaki ʻo e Lavea ʻo e Fatu ʻo e Blunt kimuʻa ʻi he Falemahakí

ʻI he aʻu mai ʻa e kau toketā fakafaitoʻó, lipooti ʻa e ngaahi meʻa mahuʻinga ʻe nima ko ʻení: * [ ] Founga 'o e uesia: Deformation 'o e uili faka'uli, ma'olunga 'o e hinga, projectile sipoti, pe lavea 'a e fusi nofo'anga 'i he tafa'aki 'o e fatafata. * [ ] Ngaue 'a e puipui 'o e fatafata mo e palpation: 'I ai 'a e konga flail fakafepaki, crackles 'o e emphysema 'i lalo 'i he kili, pe 'oku 'i lalo 'a e hui 'o e hui (hui 9 ki he 12 'i he spleen/'ate). * [ ] Manava mo e le'o: Manava (fakatu'utamaki kapau > 28 pe < 10 manava/min), cyanosis, pe tale hake 'a e toto 'oku 'i ai hono kuhu (hemoptysis). * [ ] Ngaahi veini 'o e kia mo e 'uto: Pe 'oku fakalahi 'a e ngaahi veini 'o e kia ('oku tuhu ki he pneumothorax 'o e tension pe tamponade 'o e loto) pe 'oku palapala. * [ ] Ngaahi me'a fakatu'utamaki 'o e mahaki: Ta'u motu'a 'o laka hake he 65, hisitōlia 'o e COPD/mafu, pe ngaahi faito'o fakafepaki'i 'o e toto (warfarin, apixaban, rivaroxaban, clopidogrel).

Ko e mahino ki he ngaahi me'a fakamisini 'o e fatafata flail, contusion 'o e ma'ama'a, mo e tokanga'i 'o e manava 'o e motu'a 'o e hui 'oku ne ta'ofi 'a e hypoxia fakafokifā mo e niumonia toloi. Fakakaukau ke ke fai ha ako fakamoʻoni ki he tokoni ʻuluakí pe tali fakafaitoʻo fakavavevavé ʻo fakafou ʻi hoʻo sōsaieti fakafonua ʻo e Kolosi Kulokulá pe Kulokula Kulokulá, St John Ambulance, pe ko e Kautaha Loto ʻa ʻAmeliká.

Ngaahi fehu'i 'oku toutou 'eke .¶

What does 'paradoxical chest movement' look like in a flail chest, and why does it sometimes appear 30 minutes after the crash instead of right away?

Normally, when you breathe in, your entire ribcage expands outward together, and when you breathe out, it sinks inward together. In a flail chest, two or more side-by-side ribs are broken in two or more places, leaving a patch of the chest wall completely detached from the rest of the ribcage. When the person inhales, the negative vacuum created inside the chest sucks that loose island of broken ribs inward while the rest of the chest expands outward; when they exhale, the loose patch bulges outward while the rest of the chest falls, the exact opposite (paradox) of normal breathing. Right after the injury, the patient's chest muscles often clamp down in a tight protective spasm that holds the broken ribs still, hiding the movement. After 20 to 45 minutes, those exhausted chest muscles tire out and relax, and the paradoxical inward-and-outward sucking motion suddenly becomes visible.

Why shouldn't I wrap an elastic bandage or tape tightly around someone's chest when they have broken ribs?

Wrapping tape, an elastic ACE bandage, or a tight rib belt around the chest is one of the most dangerous myths in first aid. When you strap the circumference of the chest tight enough to stop broken ribs from moving, you also prevent the healthy ribs and the uninjured lung from expanding fully. That forces the patient to breathe shallowly, causing the small air sacs at the base of the lungs to collapse and trap mucus (atelectasis). In a flail chest, tight strapping can cut lung capacity in half and trigger rapid suffocation; in a simple rib fracture, it leads directly to severe bacterial pneumonia within days. Instead, have the person hold a soft pillow gently against the sore spot with their hands when breathing deeply or coughing.

Why is a broken rib on the lower left or lower right side of the ribcage more dangerous than a broken rib higher up?

Your lower ribs (ribs 9, 10, 11, and 12) wrap directly around the two largest, most blood-filled solid organs in your upper abdomen: the liver on the right side and the spleen on the left side. Roughly 20 percent of patients with lower left rib fractures have a bruised or ruptured spleen underneath, and 10 to 15 percent of patients with lower right rib fractures have a lacerated liver. A ruptured spleen or liver can pour liters of blood into the abdominal cavity with no outside wound. If someone with lower rib pain develops pain at the tip of their left or right shoulder (referred phrenic nerve pain called Kehr's sign), dizziness, pale cold sweaty skin, a fast heart rate, or a tender tight belly, call 911, 112, or 999 immediately for internal bleeding.

Why are broken ribs so much more dangerous for someone over 65 years old than for a 25-year-old?

In a young adult, the ribcage is flexible and lung reserve is large, so an isolated broken rib usually heals over 4 to 6 weeks. In an adult over 65, brittle osteoporotic bones break more easily, chest wall muscles are weaker, and natural cough reflexes and lung elasticity are reduced. Because every deep breath or cough causes sharp pain at the fracture site, an older adult naturally breathes very shallowly and stops coughing. Within 48 to 72 hours, the unventilated bottom lobes of the lung collapse and fill with fluid and bacteria, causing life-threatening pneumonia. Any adult over 65 who suffers a suspected broken rib, even from a minor fall against a bathtub or piece of furniture, must be examined in an emergency department for X-rays, targeted pain control, and a guided deep-breathing plan.

Kuo vakaiʻi ʻa e ngaahi maʻuʻanga fakamatalá¶

Kolisi Toketā Tafa ʻAmelika (ACS, ʻIunaiteti Siteiti): Tohi Fakahinohino ki he Ako ʻa e Kau Ako ki he Poupouʻi ʻo e Moʻui ʻi he Lavea Fakalakalaka (ATLS): Lavea ʻi he Fatu, Flail Chest, Pulmonary Contusion, mo e Rib Fracture Triage.
Kautaha Hahake ki he Tafa 'o e Lavea (EAST, 'Amelika): Ngaahi Fakahinohino ki hono Pule'i 'o e Ngaue ki he Lavea 'o e Ma'ama'a - Flail Chest mo e Blunt Thoracic Trauma 'i he Kakai Lalahi Matu'otu'a.
'Inisititiuti Fakafonua ki he Mo'ui Lelei mo e Tokanga'i Lelei (NICE, Pule'anga Fakatahataha) & NHS: Ngaahi Fakahinohino Fakafaito'o ki he Ngaahi Lavea Lalahi: Pule'i 'o e Lavea 'i he Fafatafa mo e Analgesia/Physiotherapy 'o e Motu'a 'o e Hui.
Kautaha Fakafonua 'o e kau Tekinisia Fakafaito'o Fakavavevave (NAEMT, 'Iunaiteti Siteiti): Poupou ki he Mo'ui 'i he Lavea kimu'a 'i he Falemahaki (PHTLS): Lavea 'o e fatafata 'oku 'ikai ke 'asi mo e Fakatu'uma'u 'o e Pneumatic 'i loto.
Kautaha Fakavaha'apule'anga 'o e Kolosi Kulokula mo e Ngaahi Sosaieti 'o e Kulokula (IFRC, Fakavaha'apule'anga): Ngaahi Fakahinohino Fakavaha'apule'anga ki he Tokoni 'Uluaki, Fakaakeake, mo e Ako: Ngaahi Lavea 'i he Ufatafata mo e Ngaahi Motu'a 'o e Hui.