A flail chest creates a free floating, broken segment of ribs that moves opposite from the rest of the chest wall when breathing in and out. A flail chest most often occurs when there is significant blunt force to the chest.
Flail Chest Effects Breathing
According to the Emergency Nursing Core Curriculum, the flail segment may not be evident for hours after injury because of muscle spasms. The patient will also splint or guard the area of injury. Flail chest injuries are painful for the patient and because of the pain when breathing, deep breathing will not be effective in relieving pain. Normal breathing is done through a bellow effect, the lungs expand when breathing in and deflate when breathing out. The ineffective breathing with a flail chest is because there is less negative pressure to expand the lung.
Considerations
Patients with flail chest will complain of pain and shortness of breath. Their breathing will be fast and shallow because of the pain associated with the broken rib segment. A major concern with flail chest is the possibility of injuries to organs within the chest cavity, primarily the lungs. Underlying injuries could include bruising or puncture of the lungs.
Complications
A primary complication associated with flail chest is respiratory failure. Respiratory failure is the inability of the lungs to adequately exchange oxygen and carbon dioxide. Respiratory failure that is not treated can lead to death.
Medical Treatment
Patients with flail chest will require additional oxygen to assist in providing adequate oxygen and carbon dioxide exchange in the lungs. Patients will possibly be able to compensate for their oxygen needs for a period of time, but once they become fatigued, further assistance for breathing will be required. They may require a breathing tube be placed through their mouth and trachea. The tube will be connected to a mechanical breathing machine, which will breath for them. According to Critical Care Nursing Quarterly, it is not uncommon for patients to be on a breathing machine for up to three weeks as the fracture heals. Managing the pain is essential in the treatment of flail chest. Because of the amount of pain associated with a flail chest, the patient will not want to breath deeply. Providing pain control will assist in improving the breathing and oxygen exchange.
Surgical Treatment
Critical Care Nursing Quarterly indicates that in some instances a surgical repair of the broken rib segment may be considered. The decision for surgery will be based upon the size of the broken segment, degree of breathing dysfunction and other underlying injuries.
References
- "Emergency Nursing Core Curriculum"; Saunders Elsevier; 2007
- "Critical Care Nursing Quarterly"; Thoracic Trauma: Yamamoto, et al; December 30, 2004
