Flail Chest Flashcards
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.
Flail Chest
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.
Flail Chest
Lab/Imaging studies:
Non-contributory - Dx made based on history and physical exam. If possible, obtain chest x-ray.
Flail Chest
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
Flail Chest
