Flail chest
Flail chest injury
3 or more ribs fractured at 2 or more places on the rib shaft - results in area with loss of continuity with rest of rib cage and has potential to move independently during respiratory cycle
Implications of flail chest
- High mechanism injury (one rib = 150mls blood loss)
- Possible underlying pulmonary contusion
- Can lead to respiratory embarassement
- Exhibit paradoxical movement during respiratory cycle - moves inwards on inspiration
- Pain from fracture leads to reduced TV
- Type II (mechanical) failure can result
- Late complications: pneumonia, septicaemia, atelectasis
- Reduced ventilation increases risk of retained secretions and sequlae
Managment
According to ATLS principles
- Manage flail chest
- Humified oxygen
- Analgesia - paracetamol / NSAIDS / Opiates / intercostal block / thoracic epidural (up to T4) + splinting of injury
- Intubation / mechanical ventilation - if worsening fatigue and RR
- Identify underlying injury
- Prevention of secondary complications
Sucking Chest wound
- Occurs when wall defect 2/3 size of trachea diameter
- Air enters chest through hole rather than trachea
- Can lead to tension pneumo
- Rx: 3-sided dressing acting as flutter valve
