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Flail Chest What is a Flail Chest? A flail chest occurs when a segment of the thoracic wall becomes unattached from the rest of the chest wall. This most typically occurs when ribs are fractured in two places, allowing that segment of the thoracic wall to "float" independently of the rest of the chest wall. "Paradoxical chest wall motion" best describes a flail chest. Normal respiration: A, Inspiration; B, Expiration. Paradoxic motion: C, Inspiration. Area of the lung underlying unstable chest wall sucks in on inspiration. D, Expiration. Unstable area balloons out. Note movement of mediastinum toward opposite lung during inspiration. How should a flail chest be treated? Treatment of flail chest is dictated by the clinical condition and degree of respiratory distress. Local anesthetic block of the affected ribs (Bupivicaine instillation caudal to the affected ribs at the rib origin) will decrease the patient's pain. If the flail segment is impairing gas exchange or contributing to hypoxemia, the flail segment should be supported by a firm chest wrap or temporarily by laying the patient with the flail segment down against the exam table. This prevents the flail segment from moving out paradoxically during expiration. Oxygen supplementation may be necessary depending on the underlying lung pathology. Surgical stabilization of the flail segment is rarely necessary. FLAIL CHEST refers to a serious breech in the integrity of the ribcage from more than one adjacent broken ribs broken in more than one place each. Instead of rigidly holding the normal shape of the chest, flail chest results in a segment of the chest wall flailing back and forth in the opposite direction of the rest of the chest wall. This is a dangerous injury that requires emergency medical treatment. If not treated promptly, flail chest can lead to a collapsed lung or blood around the heart. Act swiftly. Practice universal precautions and wear personal protective equipment if available. Be sure that whatever caused the injury to the victim is no longer a threat. Stabilize the flail chest. Holding the flail segment in place keeps it from moving in an opposite direction as the surrounding muscle and bone. If it doesn't move, it won't cause more damage to the heart, lungs and surrounding tissues. Almost anything will do to stabilize the flail chest. Roll up a jacket or a blanket. If there is absolutely nothing available, at least have the victim lie on the affected side of the chest to discourage it from moving. Regardless how a flail chest is treated it is going to hurt, probably worse than anything the victim has ever encountered. Over the counter pain medications aren't going to do much for this level of pain Failure to provide proper treatment for flail chest can lead to pneumonia and other life-threatening conditions.