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Flail Chest

  • Flail chest is traditionally described as the paradoxical movement of a segment of chest wall caused by fractures of 3 or more ribs anteriorly and posteriorly within each rib
  • If a rib is broken in two places, then the free-floating section will no longer be able to support the underlying lung or move with the usual expansion of the ribs.
  • Such damage means the underlying lung will not expand or contract, and therefore not take part in gas exchange this is called a flail segment. The flail segment moves in the opposite direction to the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called "paradoxical breathing" is painful and increases the work involved in breathing resulting in hypoventilation. There may also be underlying lung damage and bruising due to the trauma.
  • Elderly but can be seen in children and all ages, Road traffic accidents
  • Weakened bones: inherited conditions, osteoporosis, total sternectomy, and multiple myeloma
  • CXR is diagnostic or CT scan if unsure
  • ABCDE, Pain relief, Chest drain if needed
  • May need intubation and ventilation usually needed.
  • Surgical fixation can reduce the duration of ventilatory support
  • Chest physiotherapy

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