Flail chest is a serious, life- threatening chest injury often associated with underlying lung injury and is most commonly seen in cases of significant blunt trauma to the chest.
In patients with flail chest;
Part of the chest wall separates from the rest and it moves in an opposite direction from the rest of the chest wall
This causes the chest to appear to be flailing or struggling as the patient breathes
Flail chest Causes
While rollover and crush injuries generally break ribs at only one point, for flail chest to occur, a significant impact is required — breaking multiple ribs, i.e., two or more adjacent ribs broken in two or more places. Although chest wail instability can lead to paradoxical movement of the chest wall during breathing (i.e., the flail segment moves in while victim breathes in, and moves out while the victim breathes out), this defect alone does not cause hypoxia — deprivation of oxygen.
Flail chest is invariably accompanied by pulmonary contusion—a bruise of the lung tissue that can interfere with blood oxygenation. Often, it is the contusion, not the flail segment that is the main cause of respiratory failure in patients with both injuries leading to hypoxia.
Flail Chest Symptoms
Patients with flail chest usually have difficulty in breathing
1. They are at risk of having internal injury as a result of movement of the separated piece of chest wall. Their chests are often bruised as a result of injuries that caused the flail chest.
2. Because of the pain from the broken ribs and bruises, the patient will breathe shallow, leading to respiratory failure.
3.The flail chest also indicates that the patient may have underlying trauma such as damage to the lungs or heart, which can also contribute to the patient’s difficulty in breathing.
With a significant amount of force being required to cause a flail chest, the same force can also cause other life threatening injuries with respect to airway and breathing.
All trauma victims mandate a chest X-ray to rule out all life threatening problems including the flail chest.
Flail Chest Treatment
Initial treatment of the flail chest includes;
- Providing adequate painkillers
- Ruling out other serious injuries,as sometimes flail chest can be a distracting injury while assessing a trauma victim
Definite Treatment is to ensure:
- Adequate oxygenation.
- Careful IV fluid resuscitation.
- Providing adequate painkillers.
- When used properly, local anaesthetic agents can provide excellent pain relief and prevent the need for ventilator support. However, prevention of hypoxia is of paramount importance for all trauma victims.
- Short period of mechanical ventilation may be necessary until diagnosis of the entire injury pattern is complete.
- Once the patient is stabilised, surgery can be used to address the flail chest.
- Before the surgery, patient may be intubated with a double lumen tracheal tube. In a double lumen endotracheal tube, each lumen may be connected to a different ventilator.
- Usually, one side of the chest is affected more than the other, so each lung may require drastically different pressures and flows to adequately ventilate.
- In the wake of surgery, the patient may need to spend a great deal of time resting to give the broken ribs a chance to heal without strain.
Prevention, including safer automobiles and newer airbag design may affect the incidence and outcome of these multifactorial injuries.