Flail chest

Flail chest develops when multiple consecutive ribs fracture with each rib having two or more fractures. It is caused by massive blunt force trauma to the chest. This results in a "floating segment" which is known as the flail segment. The segment shows paradoxical movement with respiration as it is independent of adjacent thoracic cage; sucked in on inspiration and pushed out on expiration. It can cause pulmonary contusion, mediastinal flutter, decreased air entry and stagnation of air in lungs. These derangements result in respiratory dysfunction and accumulation of bronchopulmonary secretions.

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Diagnosis

It can be diagnosed clinically from the characteristic paradoxical movement on respiration with history of trauma and chest X-ray is done to identify the fracture segment.

Investigations

Chest X-ray, blood grouping and arterial blood gas analysis.

Treatment

The person has to be hospitalised immediately. The initial management focuses on stabilising the patient as per the guidelines of Advanced Trauma Life Support (ATLS). The subsequent management of flail chest includes endotracheal intubation with positive pressure ventilation for improving ventilation and intercostal tube drainage as required. Analgesics and bronchodilators can be administered to relieve the pain and augment ventilation. Antibiotic prophylaxis is given to prevent infection.The fractured segment can be fixed with the aid of clips to the ribs above and below to curb paradoxical movement. The rib fractures normally heal on their own and rarely require operative fixation.



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