Flail chest traumas are usually chest deformities caused by traffic accidents and sudden blows. Flail chest, which occurs with trauma, presents symptoms such as pain and shortness of breath. So what is a flail chest, and how is it treated?
What is Flail Chest?
A flail chest is a fracture in two or more adjacent ribs resulting from high-energy traumas such as severe traffic accidents and falls.
The trauma's severity and location determine unilateral or bilateral flail chest.
Flail chest develops with severe injuries, especially sudden traumas, but it affects the whole trunk. Therefore, it is crucial to treat it early because an untreated flail chest can lead to critical problems such as thoracic lung contusion, pneumothorax, hemothorax, and shock. In this period, early diagnosis and supportive treatment are vital.
What are the Symptoms of Flail Chest?
The most common signs and symptoms of flail chest, which is extremely easy to diagnose, are as follows:
- Painful breathing
- Shortness of breath
- Difficulty breathing
- Paradoxical movements in the traumatized chest wall (collapse)
- Tachycardia
- Tachypnea
- Crepitation and subcutaneous emphysema
Flail Chest Diagnosis
Flail chest cases can be easily diagnosed with paradoxical chest movements. Approximately 5% to 15% of thoracic traumas result in a flail chest. This disease, characterized by the inward movement of the thorax during breathing and outward movement during exhalation, can be detected by symptoms such as respiratory distress. Some patients need additional imaging techniques when such rib cage movements are absent.
Chest X-ray: This method provides a clear visualization of fractures caused by trauma, but in some cases, the direction of retraction may prevent the visualization of fractures. In addition, chest radiography can also detect findings such as pneumothorax and hemothorax. Pneumothorax is a disease characterized by excessive accumulation of air in the chest cavity. Hemothorax occurs when blood accumulates in the chest wall. Both problems require immediate intervention.
Computed Tomography: CT is frequently used to detect flail chest patients. This imaging method also enables the diagnosis of vital pneumothorax and hemothorax conditions. In addition, it helps to visualize the vascular structures in the lung and the trachea in detail.
As a result, the causes of flail chest can be determined precisely by both methods. Therefore, we can define the treatment method with the help of these methods.
Flail Chest Treatment Methods
There are different treatment methods for patients diagnosed with Sailing Chest. It is very important to start early and supportive treatments. Otherwise, more serious problems may arise that cause life-threatening complications. The consequences can be fatal if treatment is delayed.
Early treatment prevents the formation of severe damage and helps to complete the treatment successfully. For this, it is essential to pay attention to the following issues in the process from post-traumatic to hospitalization:
- The patient's airway and breathing are checked.
- While in the ambulance, it is essential that the patient receives oxygen therapy and that preparations for intubation are completed. Especially in patients over 65, the carbon dioxide level is high, and the oxygen level is low; intubation may be inevitable in those cases.
- The patient should have vascular access.
After arriving at the hospital, the patient mortality rate varies between 10% and 40% compared to the first intervention. Concomitant pneumothorax and hemothorax closely affect the course of the disease. Controlling pre-hospital procedures in the hospital is essential.
External fixation can prevent paradoxical movements. The risk of more serious complications is significantly reduced in early intubated patients.
Especially if the oxygen level is low, early intubation becomes more critical. In severe cases, surgical operation is preferred to correct movements.
For this, the patient who cannot breathe is put on mechanical ventilation and the patient's chest movements are stabilized.