II. Definitions
- Flail Chest
- Paradoxical chest wall movement due to 3 or more contiguous anterior and posterio Rib Fractures
III. Pathophysiology
- Chest Trauma resulting in 2 or more contiguous Rib Fractures at 2 or more sites along each rib
- Results in paradoxical chest wall movement
- Associated with other lung injury (Lung Contusion, pain with Splinting and Atelectasis)
- Results in hypoventilation and Hypoxia
IV. Precautions: Pitfalls
- Flail Chest may initially be missed due to patient Splinting with shallow breathing
- Chest wall palpation is critical during the Trauma Secondary Survey
V. Signs
- Respiratory Rate increased (Tachypnea)
- Oxygen Saturation decreased (Hypoxia)
- Palpable chest wall deformity
- Significant pain on palpation of chest wall in vicinity of flail segment
VI. Labs
- Consider Venous Blood Gas or Arterial Blood Gas (ABG)
VII. Imaging
- See Rib Fracture
VIII. Associated Conditions
- Lung Contusion
- Pneumothorax
- Atelectasis (due to Splinting)
- Secondary Pneumonia risk
- See Rib Fracture
IX. Management
- See Primary Trauma Survey
- See Secondary Trauma Survey
- See ABC Management
- Risk of cardiopulmonary collapse (depending on associated injuries and reserve)
- Stabilize flail segment
- Supplemental Oxygen
- Pain management
- Narcotic Analgesics (e.g. Dilaudid or Morphine Sulfate)
- Consider intercostal Nerve Block
- Consider intrapleural or extrapleural Anesthesia
- Consider Epidural Anesthesia
- Consider Endotracheal Intubation
- Indicated for Respiratory Failure
X. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- (2012) ATLS, ACOS, Chicago, p. 99