TOPIC – Flail Chest

PT In Cardiopulmonary Conditions II

SUBMITTED BY : SUBMITTED TO :
Varun Arya DR. Purnima Kushwaha
19SMAS1010002
BPT 3RD YEAR 6TH SEMESTER
A flail chest describes when a segment of the rib cage breaks due to blunt
thoracic trauma, high speed motor vehicle crash and becomes unattached from
the chest wall.It can occur when 3 or more ribs are broken in at least two places,
although not everyone with type of injury will develop a flail chest.
PATHOPHYSIOLOGY :

This pathology of rib fracture associated with decrease chest movement

due to pain that reduces the tidal volume and may predispose to
significant atelectasis, impaired gas exchange in the affected lung
beneath the fractured rib, altered in breathing mechanism. All these
contributing factors may predispose later to pneumonia and pulmonary
secretions retention, paradoxical chest movement.
TYPES :

Complete
Incomplete
Physeal

CLASSIFICATION ACCORDING TO FRACTURE :

Spiral
Transverse
Comminuted
Compression
ASSOCIATED CONDITIONS :

•Haemothorax
•Pneumothorax
•Atelectasis
•Pneumonia
•Pleural effusion
•Subcutaneous emphysema
•ARDS
•Pulmonary Emboli
•Aspiration
•Lobar collapse
DIAGNOSTIC PROCEDURE:

An abnormal chest movement during

breathing may be a sign of flail chest.
Radiologists use Chest X Rays to look for the
following:
“Three or more adjacent ribs are fractured in
two or more places. Clinically this can be a
segment of only one or two ribs can act as a
flail segment”
CT is more accurate modality in severe blunt
trauma.
MEDICATIONS:

1.Simple Analgesics
2.Opioids like morphin when pain is not controlled
with simple analgesics
3.Patient Controlled Analgesia
4.Operative fixation and Regional Anaesthetic
SURGERY:

•Regional anesthesia
•Serratus anterior block
•Paravertebral block
•Thoracic epidural
INTERNAL FIXTATION:

•It is a difficult and challenging procedure due to the nature of the rib.
•Decreases stay in ICU and MV duration.
•Incision site is Similar to thoracotomy and the latissmus dorsi muscle
wasn't incised.
•Anterior fracture- plates and locking screws
•Posterior fracture - intramedullary splints
PHYSIOTHERAPY MANAGEMENT:

•Ventilatory Management : supplemental oxygen therapy, continuous positive airway

pressure or intubation if necessary
• CPAP - for negative intrapleural pressure and paradoxical movement,  increases TV
• Open/closed suction if patient intubated.
•Pain Management and Education :
• Education on fracture healing
• Early mobilization if possible to prevent contracture and loss of muscle mass
• Transfers to sitting out of bed
• Mobilization 2-3 times daily and SOOB 3-4 time/day
PHYSIOTHERAPY MANAGEMENT:

•Chest and airway clearance techniques (if inadequate) :

• ACT: nebulizer with ACBT and education
• Bubble PEP or Flutter
•Deep breathing exercises and supported coughing technique :
• Supported Cough: Wrap around technique or rolled up towel
• DBE/TEE’s with SMIs (2-4 secs hold)
•Positioning :
• Positioning in side lying and high sitting

It was recommended to apply chest physiotherapy after adequate pain relief modalities
THANK YOU