Treatment

Your treatment options depend largely on the respiratory embarrassment caused – consider:

• Your patient’s clinical condition
• The size of the flail chest
• Associated injuries
• Age
• Co-morbidities
• Destination from resus (theatre, CT scan, ITU or ward)

For patients with major trauma (apply common sense in defining this), proceed to intubation and ventilation intermittent positive pressure ventilation (IPPV).

• Take better control of respiratory compromise
• Address your patients pain (remember to give adequate analgesia post rapid sequence induction (RSI))
• Facilitate clinical procedures e.g. chest drain insertion and CT scan

Insert a chest drain for associated pneumothorax and haemothorax. CT is likely to pick up occult pneumothoraces.

Judicious fluid resuscitation since excessive fluid floods injured lung tissue.

Definitive surgery (internal fixation of ribs) at the discretion of cardiothoracic surgeons.

Discuss treatment options with ICU and thoracic surgical colleagues for patients with a flail segment causing limited respiratory embarrassment, and in whom there are no other life-threatening injuries. A conservative approach might include the use of thoracic epidural [1], intercostal nerve blocks or patient controlled analgesia, and continuous positive airway pressure (CPAP) and physiotherapy.