II. Definitions

  1. Flail Chest
    1. Paradoxical chest wall movement due to 3 or more contiguous anterior and posterio Rib Fractures

III. 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

IV. 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

V. 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

VI. Labs

VII. Imaging

VIII. Associated Conditions

IX. Management

  1. See Primary Trauma Survey
  2. See Secondary Trauma Survey
  3. See ABC Management
  4. Risk of cardiopulmonary collapse (depending on associated injuries and reserve)
  5. Stabilize flail segment
  6. Supplemental Oxygen
  7. 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
  8. Consider Endotracheal Intubation
    1. Indicated for Respiratory Failure

X. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. (2012) ATLS, ACOS, Chicago, p. 99

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