Trauma to the chest resulting in multiple, consecutive rib fractures can cause a portion of the rib cage to detach. The resulting instability of the chest wall causes paradoxic chest movement with each breath, resulting in inadequate ventilation.
Trauma to the chest wall prevents normal expansion of the lung, limiting a patient’s ability to adequately ventilate. As a result, patients will likely be short of breath and breathe using rapid, shallow breaths in an attempt to compensate.
Patients with flail chest will experience sharp chest pain related to irritation of lung tissue caused by broken bones in the chest.
In uninjured patients, the chest expands with inspiration, and contracts with expiration. In patients with consecutive rib fractures; however, movement of the chest is paradoxical. Patients with flail chest will present with chest contraction during inspiration (flail area sucked in), and chest expansion (flail area bulges out) during expiration. Chest movement is asymmetric and uncoordinated.
Intubation and mechanical ventilation may be necessary for some patients, in an effort to reestablish lung expansion and to ensure adequate ventilation and oxygenation. Bag-valve-mask ventilation should be performed using 100% oxygen.
Pain management is essential and will allow the patient to increase the tidal volume of each breath, thereby improving ventilation and increasing oxygenation of the blood. Narcotics should be avoided, as these medications can induce respiratory depression.
Intercostal nerve blocks, and epidural or intrathecal analgesia, are highly recommended for effective pain management in patients with flail chest.
Surgical fixation of the ribs may be performed, as this intervention has been shown to reduce the amount of time that the patient is subjected to mechanical ventilation.
Pulmonary contusion is a life-threatening condition that is characterized by pooling of blood in the alveoli of the lungs after injury or trauma to the lung tissue. Patients should be monitored closely and suctioned as needed to maximize positive outcomes. Damage to the lung may also result in a pneumothorax or collapsed lung.
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