What is Flail chest and stove in chest?

o   It is the fracture of two or more consecutive ribs, with each rib having two or more fracture sites. Such a segment is called the flail segment.

o   Stove in the chest is the depression of a portion of the chest wall due to severe chest injury.

Pathophysiology of  Flail chest and stove in chest:

·        Flail chest moves independently of the adjacent thoracic cage. During inspiration, flail segment moves inwards and during expiration, it moves outwards causing pathophysiological derangements.

·        This paradoxical respiration causes a reduction in ventilatory lung surface and so respiratory dysfunction.

What is Mediastinal flutter?

Ø  Mediastinal Flutter is the movement of mediastinum during different phases of respiration occurs, often causing kinking of great vessels and sudden cardiac arrest.

Ø  Pendular movement of air from one lung to another occurs and thus preventing atmospheric air to get into both injured and Otherside normal lung leading to respiratory failure.

All these derangements get aggravated by haemothorax, pneumothorax, and other associated injuries.

There is hypoventilation: Carbon dioxide retention and respiratory failure.

What should we do as first-aid in Flail chest?

The paradoxical movement of the the flail segment is prevented by applying pressure over it using hand or clothes. It is often life-saving. It makes other lung function adequately.

Investigations:

ü  Chest X-ray: to identify the fracture segment

ü  Blood grouping

ü  Arterial PO2 and PCO2 and serum electrolytes

Treatment

v Intercostal tube drainage

v Applying clips to fracture ribs and fixing above and below to normal ribs

v Antibiotics like penicillin, cefotaxime

v Blood transfusion, IV fluids

v Bronchodilators, steroids

v Ventilator support with IPPV- IPPV is the treatment of choice. Assisted ventilation is required for several days until the chest wall stabilizes. If ventilator support is required more than 10days, then tracheostomy is done to prevent

v Laryngeal stenosis which can occur due to prolonged endotracheal intubation.

v Thoracotomy-When required