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Troublesome Injuries
Flail chest
• Fracture of 2 or more consecutive ribs in
at least 2 places each
• About 30-40% of patients need
mechanical ventilation
• ARDS is increased 20-30% in the
presence of flail chest
Flail Chest
Flail chest
Flail Chest
Flail Chest
• Incidence
– Most common cause: vehicular crash
– Falls from heights
– Industrial accidents
– Assault
– Birth trauma
Flail Chest
• Significant chest trauma
• Mortality rates 20% to 40% due to
associated injuries
• Mortality increased with
– Advanced age
– Seven or more rib fractures
– Three or more associated injuries
– Shock
– Head injuries
Flail Chest
Assessment Findings
• Chest wall contusion
• Respiratory distress
• Paradoxical chest wall movement
• Pleuritic chest pain
• Crepitus
• Pain and splinting of affected side
• Tachypnea
• Tachycardia
• Possible bundle branch block on ECG
Flail Chest is a True
Flail Chest
Pathophysiology (2 of 2)
• Respiratory failure due to:
– Underlying pulmonary contusion
• The blunt force of the injury typically
produces an underlying pulmonary
– Associated intrathoracic injury
– Inadequate bellows action of the chest
Treatment of Flail Chest
• ABC’s with c-spine control as indicated
• High Flow oxygen that may include BVM
• Monitor Patient for signs of Pneumothorax
or Tension Pneumothorax
• Use Gloved hand as splint till bulky
dressing can be put on patient
• Contact hospital and ALS Unit as soon as
Troublesome Injuries
Flail chest
• Close monitoring of respiratory
• Adequate analgesic therapy
• Provide oxygen therapy and ventilatory
• Aggressive pulmonary toilet
Flail Chest
• Airway and ventilation
– High-concentration oxygen.
– Positive-pressure ventilation may be needed.
• Reverses the mechanism of paradoxical chest wall
• Restores the tidal volume
• Reduces the pain of chest wall movement
• Assess for the development of a pneumothorax
– Evaluate the need for endotracheal intubation.
– Stabilize the flail segment (rib clipping).
Bulky Dressing for splint of Flail
• Use Trauma bandage
and Triangular Bandages
to splint ribs.
• Can also place a bag of
D5W on area and tape
down. (The only good
use of D5W I can find)
• Not recommended
anymore --> better
consult to stabilize
BLS Plus Care
• Monitor Cardiac Rhythm
• Establish IV access
• Airway management to include Intubation
• Observe for patient to develop Pneumothorax
and even worse Tension Pneumothorax
• If Tension Develops Needle Decompress
affected side
• Rapid Transport! Remember a True Emergency