Flail Chest
Stabilization of the flail segment in the ED or prehospital setting has not been shown to be helpful, and aggressive stabilizing efforts impede overall thoracic mechanics - John Bailitz and Tarlan Hedayati
HWN Suggests
Understanding of flail chest injuries and concepts in management
In literature, the treatment of flail chest still remains controversial...
With the advancement in intensive care techniques, the management of the flail chest has evolved considerably over the recent years. Conservative management of a flail chest comprises maintenance of positive intrathoracic pressure to assist the spontaneous ventilatory effort of the patient and reduce the dissynchronous movement of the flail, thus helping the lung expansion.
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EMS Says Flail Chest, But Is It?
. In this case, the patient’s pneumothorax was decompressed into a large soft tissue defect in his chest wall. The extensive chest-wall disruption resulted in soft tissue emphysema that was bulging with respirations mimicking a flail chest.
Articles of Interest
Emergency Strategy - How to treat flail chest
Continuous positive airway pressure via face mask is given to patient if he cannot maintain the partial pressure of oxygen more than 80mmHg despite high flow of oxygen. Other alternative include nasal bilevel positive airway pressure. If the above intervention fail consider mechanical ventilation or endotracheal intubation that act as physiologic internal fixation of the flail segment.
Flail Chest
An uncommon injury caused by three or more rib fractures in two places...
Flail Chest and Pulmonary Contusion
Respiratory dysfunction usually does not arise from the paradoxical chest motion but rather is due to underlying contusions and splinting from pain.
Pattern of Flail Chest Injury Secondary to Blunt Chest Trauma in Menoufia University Hospital
Flail chest is usually associated with other chest injuries such as: hemothorax, pneumothorax, pulmonary contusion, or any combination of these.
Resources
Thoracic Trauma
Flail chest occurs when three or more ribs are fractured in two or more places and a discontinuous segment of the thoracic wall is produced and moves paradoxically with respiration. Flail chest is diagnosed in approximately 5% of thoracic trauma patients seen in level I trauma centers, typically in the setting of multisystem trauma. Mechanisms include MVCs, crush injuries, assault, falls, and even minimal trauma in elderly patients. Respiratory insufficiency results primarily from the underlying pulmonary contusion. Pneumothorax occurs in 50% of cases and pulmonary contusion in 75%.
GrepMed
Video... A serious case of Flail chest. This is a medical emergency!
OrthoBullets.com
Pain control, systemic narcotics or local anesthetics. Positive pressure ventilation...
Physiopedia
A flail chest is described when a segment of the rib cage breaks due to blunt thoracic trauma, high speed motor vehicle crash and becomes unattached from the chest wall.[1]It can occur when 3 or more ribs are broken in at least two places, although not everyone with this type of injury will develop a flail chest. However, when these injuries cause a segment of the chest to move independently, the generation of negative intrapleural pressure indicates a true paradoxical flail segment[2]. This condition is of clinical significance in elderly patients or patients who have chronic lung disease, associated with morbidity and mortality.
Radiopaedia
Clinically, this is observed in a non-ventilated patient as a paradoxical movement of the flail segment. It can often be clinically occult. Its significance lies in the fact that it can lead to severe ventilation difficulties, especially in the peri-intubated patient.
StatPearls
Flail chest is a traumatic condition of the thorax. It may occur when 3 or more ribs are broken in at least 2 places. It is considered a clinical diagnosis as everybody with this fracture pattern does not develop a flail chest.
