What is a Flail Chest?

When two or more adjacent ribs in two or more places of the rib cage are fractured (broken), allowing for the unrestricted movement of the broken segment, it is known as flail chest. Some medical sources say the number of ribs is three or more. This is one of a number of closed chest injuries that can be caused by blunt trauma or being struck very forcefully, and by compression injuries such as a vehicle falling on someone. It's not difficult to imagine the injury and damage to the vital organs of the chest such as the heart and lungs that can be done.

Flail chest can be thought of as a segment of ribs that has been broken lose from the rest of the rib cage, permitting this fractured segment to freely "float" away from the cage. When the rib cage expands during inhalation, negative pressure draws in the flail segment. This causes the broken part of the rib cage to move inward while the rest of the cage is moving outward. When the patient exhales, positive pressure is created and pushes the flail chest outward causing it to move in the opposite direction of the rest of the cage that is moving inward. This is known as paradoxical motion.

Paradoxical motion is very difficult to detect in the early stages because of the tightening of the muscles of the chest wall that produce somewhat of a natural splint, providing some stabilization of the flail chest. While this might sound beneficial, and it is, tightening of these muscles increase the patient's work to breath, causing fatigue to set in. This is when the evidence of flail chest becomes easier to see.

Treatment of Flail Chest

While there's not a lot that can be done in the field before emergency medical services (EMS) arrives, it's a good idea to know what to do to attempt to stabilize the flail chest. EMS will provide oxygen which not only benefits the entire body in times of distress, but also helps somewhat with the discomfort associated with this type of injury. Bulky dressings can be used to help to stabilize the independently floating fracture rib segment. The dressing is taped into placed in a way that it doesn't interfere with the normal expansion of the chest or encircle it.

Nursing students and those who are studying to work as an emergency medical technician (EMT) might want to view videos showing paradoxical motion to help train their eye to detect flail chest. Again, it's very difficult to see until it has advanced, but the experienced eye can detect it in the earlier stages so that needed interventions are performed.

Source:

NREMT certified, state licensed EMT with local fire department