flail chest

chest (chest) thorax.

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flail chest  one whose wall moves paradoxically with respiration, owing to multiple fractures of the ribs.

funnel chest  pectus excavatum.

pigeon chest  pectus carinatum.

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flail chest

n.

The loss of stability of the thoracic cage following multiple fractures of the ribs with or without accompanying fracture of the sternum.

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flail chest

[flāl]

Etymology: ME, fleyl, whip; AS, cest, box

a thorax in which there are two fractures on at least two adjacent ribs causing instability in part of the chest wall and paradoxic breathing, with the lung underlying the injured area contracting on inspiration and bulging on expiration. If it is uncorrected, hypoxia will result.

observations Flail chest is characterized by sharp pain; uneven chest expansion; shallow, rapid respirations; and decreased breath sounds. Tachycardia and cyanosis may be present. Potential complications include atelectasis, pneumothorax, hemothorax, cardiac tamponade, shock, and respiratory arrest. Often other traumatic injuries are present in a patient with a flail chest.

interventions The treatment of choice is internal stabilization of the chest wall through the use of positive pressure. Bilevel positive pressure or mechanical ventilation may be used. If the patient breathes against the automatic ventilator, a sedative and muscle relaxant may be ordered to achieve ventilatory control. Chest tubes may be required to remove air or fluid that is preventing expansion of the affected lung, and a nasogastric tube may be ordered to provide food and fluids. The patient's vital signs and breath sounds are checked every 1 to 4 hours, temperature is measured every 2 to 4 hours, and arterial blood gases are monitored as ordered.

nursing considerations The patient with flail chest usually requires a long period of care involving frequent repositioning, scrupulous attention to the patency and cleanliness of the tracheostomy or endotracheal tube, skin care, oral hygiene, pain management, and emotional support. The nurse performs passive range-of-motion exercises involving the extremities, explains the various procedures, and provides a pad and pencil or a magic slate with which the patient can communicate.

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flail

exhibiting abnormal or pathological mobility, as flail chest or flail joint.

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flail chest

a loss of stability of the chest wall due to multiple rib fractures or detachment of the sternum from the ribs as a result of a severe crushing chest injury. The loose chest segment moves in a direction which is the reverse of normal; that is, the segment moves inward during inspiration and outward during expiration (paradoxical respiration). Other manifestations of flail chest include shortness of breath, cyanosis, and extreme pain in the area of trauma.

flail joint

an unusually movable joint.

flail segment

the portion of skin, chest-wall or other structure lacking stability.

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flail chest

Traumatology Paradoxic movement of the anterior chest wall during inspiration, as the free-floating 'flailed' part of the wall moves inward as the chest expands, in response to the negative intrathoracic pressure; FC is caused by multiple anterior rib fractures, often due to MVAs or aggressive CPR