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
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Related Studies
| Definition (MSH) | A complication of multiple rib fractures, rib and sternum fractures, or thoracic surgery. A portion of the chest wall becomes isolated from the thoracic cage and exhibits paradoxical respiration. |
| Concepts | Finding (T033) |
| MSH | D005409 |
| ICD9 | 807.4 |
| ICD10 | S22.5 |
| SnomedCT | 157198006, 78011002 |
| LNC | LA17342-9 |
| English | Chest, Flail, Chest, Stove-in, Flail Chest, Stove in Chest, Stove-in Chest, flail chest, flail chest (diagnosis), Flail Chest [Disease/Finding], chest flailed, chest flail, Flail chest, Flail chest (disorder), flail; thorax, thorax; flail |
| Italian | Torace con respirazione paradossa, Parete toracica flaccida |
| Swedish | Instabil bröstkorg |
| Japanese | ﾌﾚｲﾙﾁｪｽﾄ, 胸郭固定不全, フレイルチェスト, 動揺胸, 動揺胸郭, 胸郭のストーブ |
| Czech | dýchání paradoxní, Nestabilní hrudník |
| Finnish | Hetkurinta |
| Russian | GRUDNAIA KLETKA PATOLOGICHESKI PODVIZHNAIA, ГРУДНАЯ КЛЕТКА ПАТОЛОГИЧЕСКИ ПОДВИЖНАЯ |
| Korean | 동요흉 |
| Polish | Klatka cepowa |
| Hungarian | Instabil mellkas |
| Norwegian | Ustabil brystkasse med paradoksal respirasjon, Flail chest |
| Dutch | fladder; thorax, thorax; fladder, fladderthorax, Fladderthorax, Ribluikthorax, Thorax, fladder- |
| Spanish | tórax inestable (trastorno), tórax inestable, Tórax flotante, Tórax Azotado, Tórax Paradójico |
| Portuguese | Mobilidade torácica paradoxal, Tórax Amassado, Tórax Fundido |
| German | Brustwandflattern, Instabiler Thorax, Thorax, instabiler, Thorax, eingedrückter |
| French | Volet thoracique, Volet costal, Volets costaux |
