Flail Chest

Question 1

General Considerations:

• Occurs when a segment of the chest does not have bony contiguity with the rest of the thoracic cage.
• When negative intrathoracic pressure is generated on inspiration, flail segment moves inward, reducing tidal volume.
• Usually a significant blunt force is required, e.g., motor vehicle collision (MVC) or a fall from a height.
• Major problem is respiratory failure due to the underlying pulmonary injury.

Answer 1

Flail Chest

Question 2

Physical Findings:

• The two major symptoms are pain and respiratory distress.
• Tachypnea with shallow respirations secondary to pain will be seen.
• Paradoxical chest wall movement may not be seen in a conscious patient due to splinting of the chest wall.
• Crepitus is often present.
• Even with marked, the patient may be able to compensate initially for the reduced tidal volume by hyperventilating.
• When fatigue or underlying pulmonary injury develops, frank respiratory failure may supervene.

Answer 2

Flail Chest

Question 3

Lab/Imaging studies:

Non-contributory - Dx made based on history and physical exam. If possible, obtain chest x-ray.

Answer 3

Flail Chest

Question 4

Treatment:

Supplemental oxygen is the first-line treatment.
Oxygen
Used to correct hypoxia.
2 - 15 L/min based on oxygen saturation and respiratory effort.
Nasal cannula, simple mask, non-rebreather mask, or advanced airway

Toridol so you dont have to break your CSIB
Pain control with intravenous morphine or fentanyl should be instituted early.
Fentanyl (Sublimaze) – Opioid.
Dose: 50-100 mcg IV/IM q 1-2 hours as needed.

Consider early intubation and mechanical ventilation.
* About 50% of patients will need immediate intubation.
* Indications for early ventilation would include marked hypoxia or inadequate breathing.

External chest wall supports (taping, sandbags) are not indicated.
* MAY reduce pain with movement of the flail segment but WILL reduce vital capacity and may worsen respiratory function and are therefore not indicated.

Disposition:
Medical Evacuation

Answer 4

Flail Chest