Orthopedics Book

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Flail Chest

Aka: Flail Chest
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  1. Pathophysiology
    1. Chest trauma resulting in 2 or more contiguous Rib Fractures at 2 or more sites along each rib
    2. Results in paradoxical chest wall movement
    3. Associated with other lung injury (Lung Contusion, pain with Splinting and Atelectasis)
      1. Results in hypoventilation and Hypoxia
  2. Precautions: Pitfalls
    1. Flail Chest may initially be missed due to patient Splinting with shallow breathing
    2. Chest wall palpation is critical during the Trauma Secondary Survey
  3. Signs
    1. Respiratory Rate increased (Tachypnea)
    2. Oxygen Saturation decreased (Hypoxia)
    3. Palpable chest wall deformity
      1. Significant pain on palpation of chest wall in vicinity of flail segment
  4. Labs
    1. Arterial Blood Gas (ABG)
  5. Imaging
    1. Chest XRay
  6. Associated Conditions
    1. Lung Contusion
    2. Splinting with secondary Atelectasis and secondary Pneumonia risk
      1. See Rib Fracture
  7. Management
    1. Stabilize flail segment
    2. Supplemental Oxygen
    3. Pain management
      1. Narcotic Analgesics (e.g. Dilaudid or Morphine Sulfate)
      2. Consider intercostal nerve block
      3. Consider intrapleural or extrapleural anesthesia
      4. Consider Epidural Anesthesia
    4. Consider intubation
      1. Indicated for respiratory failure

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