Severe crash injuries involving the chest often cause fracture to the ribs. Flail chest is an
emergency situation that occurs when three or more consecutive ribs on the same side of the chest become broken or fractured, each in two or more places. It results in a section of the chest wall that is unsupported, unstable and moves independently of the chest wall. Usually, the movement is opposite the direction of the rest of the wall. This is also called paradoxical motion or paradoxical respiration. In some cases, the breastbone or the sternum is broken away from its attachment to the ribs. Both of these problems are called flail chest. We can help victims with this kind of problems if we have our knowledge when it comes to First Aid and CPR courses.
Flail chest is more commonly seen in traffic accidents or motor vehicle accidents, usually when the victim’s chest is forced against the steering wheel. It may also occur as a result of other crashing injuries to the chest such as in sports- or occupation-related accidents. Forceful blows or impact to the back can also cause rib fracture, with damage usually affecting the sides of the chest walls.
Signs and symptoms of flail chest
- Paradoxical movement of a section of the chest wall – the affected section moves outward as the victim exhales while the rest contracts, and the affected section draws in when the victim breathes in while the rest expands
- Obvious sign of fractured chest
- Possible signs of shock
- Other symptoms:
- Chest pain
- Difficulty drawing breath
- Bruises or discoloration in the chest area
Care for flail chest
The goal of emergency care is to stabilize the affected section of the ribs. However, do not attempt to strap, bind or tape the injured section of the chest wall. To stabilize the flail section, you should
- Gently feel the injured site and locate the edges of the flail chest.
- Apply bulky dressings (about several inches thick) over the injury site. You can use other light-weight items such as pillow or rolled cloth, depending on the site of injury.
- Secure the pad using large strips of tape. If there is no tape, position the victim on the affected side of the chest.
- Continuously monitor for breathing, heart rate and possible injury to internal organs while waiting for the ambulance. Administer supplemental oxygen, if available.
- Monitor for signs of shock.
- Transport the victim in a semi-sitting position. If the victim cannot tolerate semi-sitting position, place him on the injured site. This will help prevent the paradoxical motion of the flail chest and minimize damage to surrounding tissues.
Basic first aid training courses normally include an overview for the care of victims of chest injuries and fracture. But if you want to gain advanced knowledge and skills in the care of flail chest, especially for emergency medical technicians and other healthcare professionals, you should consider taking an advanced first aid course for health professionals. You can inquire with your local workplace approved chapter for available schedule.