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Hannah's web series 'S-Band'Primary surgery vol. http://buyviagraonlinediscountcoupons.accountant 2 â€“ trauma primary surgery vol. 2 â€“ trauma : thoracic injuries : flail chest 65. 6 flail chest this is one of the really grave emergencies. If a patient is thrown forcefully onto the steering wheel of his car, it may push in part of his rib cage, and break several of his ribs at the front and the back. no prescription cheap viagra These fractures may be so aligned with one another that they isolate part of his chest wall. When he inspires, this part of his chest wall moves inwards also (paradoxical movement). He breathes with difficulty, because air can now move from one lung to another, instead of being exhaled. The result is dyspnoea, hypoxia, cyanosis, and carbon dioxide retention, which are especially dangerous if he is older or bronchitic. viagra or viagra review Multiple fractured ribs cause such great pain and muscle spasm that he tries not to cough. This encourages fluid to collect in his lungs and further spoils their function. generic viagra Tragically, paradoxical respiration is often overlooked. Figure 65. 9: the mechanism of a flail chest. When the patient inspires and his chest expands, the flail section sinks in, and his mediastinum moves towards the normal side. viagra daily how long to take effect When he expires, the flail section moves out and his mediastinum moves to the other side. The dotted lines show some air moving uselessly from one lung to the other. All this greatly impairs his ability to ventilate his lungs. Adapted from an original painting by frank h. Netter, m. D. From the ciba collection of medical illustrations. cheap online viagra Copyright by ciba pharmaceutical company, division of cibaâ€“geigy corporation. viagra soft online A patientâ€™s fractured ribs may be anywhere. Sometimes, the front or side of his chest moves paradoxically. Or, he may extensive fractures on either side of his spine, which allow large part of his chest wall to be pulled downwards by his diafragm. Paradoxical movement is less severe when he has fractures at the apex of his rib cage, or under his scapulae, because shoulder girdle can splint his broken ribs. can you buy viagra online yahoo answers Many broken ribs bleed severely, and cause a large pneumothorax. viagra for the brain modafinil Sometimes, a patientâ€™s underyling lung is injured so that he has a pneumothorax, perhaps under tension. The best way of treating the paradoxical movement caused a flail chest is to use internal pneumatic fixation with. has been selected for Raindance Film Festival and nominated for Best UK Web Series. Click HERE to check it out.