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Flail Chest, Emergency Medicine

Stephen L. Thornton Reviewed 06/2017
 


Basics

Description

  • Free-floating segment of chest wall:

    • 3 or more adjacent ribs are fractured in 2 or more places.

    • Rib fractures in conjunction with sternal fractures or costochondral separations

  • The free...

Diagnosis

Signs and Symptoms

History

  • Blunt thoracic trauma by any mechanism

  • Mechanism as described by patient, parent, or pre-hospital personnel:

    • Seat belt usage

    • Steering wheel damage

    • Air bag deployment

  • Loca...

Treatment

Pre-Hospital

  • Positioning the patient with the injured side down can stabilize the involved chest wall:

    • Improve ventilation in noninjured hemithorax.

  • Thoracic trauma with significant mechanism o...

Follow-Up

Disposition

Admission Criteria

All patients with flail chest should be admitted to critical care setting for close monitoring and adequate pain control. 

Discharge Criteria

Patients found to hav...

Pearls and Pitfalls

  • Early pain control is key.

  • Beware of concomitant injuries such as pulmonary contusion and pneumothorax.

  • Elderly patients have significantly poorer outcomes.

Additional Reading

  • Eckstein  M, Henderson  S. Thoracic trauma. In: Marx  J, Hockberger  R, Walls  R, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice, 7th ed. St. Louis, MO: Mosby; 20...

Codes

ICD9

807.4 Flail chest 

ICD10

  • S22.5XXA Flail chest, initial encounter for closed fracture

  • S22.5XXB Flail chest, initial encounter for open fracture

SNOMED

  • 78011002 Flail chest (disorder)

  • 311409007 Open...

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