Flail Chest

A flail chest occurs when a portion of the chest wall does not have bony continuity with the remainder of the thoracic cage, i.e. a rib is fractured in two different places and multiple ribs are involved. This leaves the chest wall unstable and causes it to move paradoxically. The hypoxia associated with flail chest is less a result of the actual mechanical paradoxical motion, and clinically the most significant problem is the underlying pulmonary contusion.

Previous historical recommendations have included placing towel clips over the chest to try to stabilize the chest, but generally if one wants to simply stabilize the chest then rolling the patient onto the affected side would be just as effective in preventing the paradoxical motion. Realistically, however, this should rarely, if ever, be done, and the patient should only undergo endotracheal intubation for effective oxygenation and to stabilize the chest.

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