Flail chest is when a segment of the thoracic cage is separated from the rest of the chest, a condition known as flail chest exists. Flail chest is usually defined as when two fractures exist on a rib which produces a free segment which cannot contribute to lung expansion. As the ribs are damaged, it can cause breathing to stop and require forced respiration.
When the patient breathes in, the flail section will fall and when they breathe out the flail section will be forced out.
Where there is a flail chest, this is a very serious condition and there is likely to be additional damage to the chest and lungs. Other conditions such as a collapsed lung know as a pneumothorax could exist. This is where the lung cannot inflate as there is damage and air have leaked into the chest cavity. In about one-third of cases where three or more ribs are fractured, a pneumothorax occurs.
Common causes of flail chest are impact injuries, like those caused by car accidents by seat belts. You will see bruising, grazes and often the chest will not rise and fall in a normal manner but this may not be visible until they are laying flat. If conscious they will complain of pain when they breathe and when you touch their chest. They will also shallow breathe as this is less painful.
Treatment is to try and sit them up, they may hold their chest which may help them. This will give the best chance of a healthy gas exchange. This may not be possible if the person has a spinal injury or they are in hypovolaemic shock.
Patients over 65 years old, fractures on both sides of the chest or where three or more ribs have been fractured, this condition can be very serious.
If available Oxygen should be given to maintaining their oxygen saturation levels.
A patient with flail chest needs immediate medical attention.