Flail Chest: Symptoms & Treatment

Instructor: Kirstyn Wade

Kirstyn is a registered nurse and has a master's degree in Nursing Education. She has taught college Nursing courses.

Flail chest, typically a result of trauma to the chest wall, is a medical emergency. If not treated promptly it can lead to serious complications. This lesson will describe flail chest, including the symptoms and treatment of this condition.

Chest Trauma

After a motor vehicle accident, first responders evaluate Steven's condition. He is alert and responsive, but is having difficulty breathing and extreme chest pain. The emergency response providers rushed him to the hospital to be further evaluated. The ED physician examines Steven thoroughly, and notices some seatbelt bruises across his chest. Additionally, one side of his chest seems to be expanding more than the other side. The physician immediately orders a chest x-ray.

What is Flail Chest?

The ED physician thinks Steven might have flail chest, or a fracture of at least three ribs in two or more places causing the affected segment to become separated from the chest wall. During normal inspiration, or breathing in, the chest muscles surrounding the ribs contract, and pressure in the lungs decreases creating a vacuum to allow air to rush in. During normal expiration, or breathing out, the opposite happens. Chest muscles relax which increases internal pressure causing air to be forced out of the lungs.

When a person experiences flail chest, the affected section of ribs moves independently of the rest of the chest wall, and in the opposite direction. So when a person breathes in, the flail section will be pulled in while the rest of the chest expands outward, and vice versa.

Diagram of a flail chest segment on inspiration and expiration.
Flail Chest

The injury to the ribs and disruption of normal breathing can quickly cause other complications, including pneumonia, a lung infection, pneumothorax, a collapsed lung, or a pulmonary contusion, which is a bruise to the actual lung causing accumulation of blood and fluid in the lung. Any of these complications can become life threatening if not treated appropriately.

Pneumothorax

What Are the Symptoms of Flail Chest?

Flail chest is most frequently caused by blunt trauma to the chest, such as a fall or motor vehicle accident. It can also be caused by bone deterioration or disease, but this is very rare.

The most common symptoms of flail chest are:

  • Chest pain
  • Pain and tenderness of the affected area
  • Inflammation and bruising on the chest
  • Difficulty breathing
  • Uneven chest rise
  • Seatbelt marks (if in a motor vehicle accident)

How is Flail Chest Treated?

Doctors first examine the chest for bruises or punctured blood vessels, as well as the condition of the ribs themselves. Some fractures of the ribs are not easily seen by initial examination, so a doctor may order a chest x-ray or multiple chest x-rays to accurately visualize the chest structures.

Treatment of flail chest is aimed primarily at protecting the individual's lungs. While broken ribs are problematic, the bigger concern is the damage to the lungs from the flail chest portion, causing pneumonia, pneumothorax or a pulmonary contusion.

When a physician diagnoses flail chest, the patient will be given supplemental oxygen to breath in through a face mask, and pain medication to help with the discomfort.

Oxygen being delivered via face mask.
Oxygen Mask

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