Flail chest – What are the signs and symptoms, relevant dDx., sequelae, work up, and treatment options?

Flail chest is caused by free floating segments of the chest wall due to more than two rib fractures at more than two sites each, usually due to underlying lung contusion. It is a life threatening, medical emergency.

Sn. & Sx.:

• Dyspnea
• Paradoxical, abdominal movement of flail segment
• Palpable crepitus of ribs
• Decreased inspiration on affected side

dDx.:

• Acute respiratory distress syndrome
• Congestive heart failure 
• Pulmonary edema
• Myocardial infarction
• Pericarditis
• Cardiac tamponade
• Pulmonary embolism

Sequelae:

• Pneumothorax
• Cyanosis
• Hypoxia
• Death

Work up:

• Imaging (rib fractures, lung contusion on chest X-ray)
• Arterial blood gasses (decreased oxygen pressure, increased carbon dioxide pressure

Tx.:

• Oxygen (positive pressure ventilation)
• IV fluids

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This post was written by Omar Rifai