Volume expansion protocol (VEP) desired every 2-3 hours (every 4 hours can be done on floor 6 requiring continued IV opioids and/or IMU status 24 hours after admission.Oxygen requirement ≥ 5 L/min nasal cannula.Incentive spirometer (IS) volumes ≤ 15 cc/kg IBW, or.Any age with a series of fractures and/or flail segment or chest and: Surgical factors to be optimized include accurate placement with minimal posterior cortical destruction, 80 pedicle fill without pedicle wall breach so as.Age > 45 with a series of four or more fractures and/or flail segment or chest.(1).Trauma patients being admitted to SIMU or with ≥ 2 rib fractures should be admitted to trauma service.Three or more fragments, main fragments have contact after reduction. Men: 50 kg + (2.3kg*(height in inches – 60)) One fracture line, cortical contact between fragments exceeds 90 after reduction.Flail chest – three or more consecutive ribs with two or more fractures in each rib with clinical paradoxical chest wall movement.Flail segment – three of more consecutive ribs with two or more fractures in each rib without clinical paradoxical chest wall movement (i.e.Posterior – posterior to the posterior axillary line (vertical line through the tip of the scapula).Lateral – between anterior and posterior axillary lines.Anterior – anterior to the anterior axillary line (vertical line from the intersection of the posterior border of the pectoralis major and the second rib).Series of fractures – fractures on neighboring ribs.Complex – at least two fracture lines with one or more fragments that span the width of the rib.Wedge – a wedge fracture has a second fracture line that does not span the whole width of the rib In impacted fractures, bone fragments are driven into each other, shortening the bone these fractures may be visible as a focal abnormal density in trabeculae.Simple – single fracture line across the rib with no fragmentation or comminution.Displaced – no cortical contact between fracture surfaces.Offset – some cortical contact between fracture surfaces, but less than 90%. ![]() Undisplaced – >90% contact between the fracture cortical surfaces.Purpose: To standardize treatment of multiple rib fractures or flail chest.
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