flail chest

see also:

• fractured ribs
• trauma to the chest

• the flail segment moves paradoxically (ie. moves in when the rest of the chest is expanding and out when the rest of the chest is moving in).
  • this paradox will only be present in the spontaneously breathing patient, as mechanical ventilation will cause all segments to move the same way at the same time.
• a flail chest is invariably associated with underlying lung contusion.
• many can be managed with analgesia, and careful fluid administration.
• if ventilation appears inadequate, consideration should be given to early mechanical ventilation.
  • the requirement for this is not related to the size of the flail alone, but rather to the underlying lung contusion.
  • respiratory function will usually deteriorate over the first 24–48 hours after a lung contusion.
• stabilization of the segment with manual or object pressure restricts chest wall expansion thereby interfering with proper respiratory mechanics and is NO LONGER USED.