flail chest

Introduction

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.