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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Related Studies

Ontology: Flail Chest (C0016196)

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
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