immediately developed air hunger, failure of the flail chest segment, and stridor, a high-pitched crowing sound produced when a patient is trying to force air through a swollen upper airway.
s physicians had tried to manage a trauma case without appreciating the special needs of a patient with flail chest.
The resident challenged the case on causation, claiming that more than 60 percent of flail chest patients do not survive.
Flail chest refers to a segment of the chest wall that is isolated from the remainder of the thoracic cavity due to multiple rib fractures.
Flail chest is a rare, but serious, sequela of blunt chest wall injuries, occurring in 5 to 13% of patients with thoracic trauma.
Flail chest in children has been documented less frequently than injury to the underlying structures, including the lungs, heart, and mediastinum.
1,13,14) However, in 1975, Trinkle et al concluded that many patients with flail chest could be managed in a manner similar to that used in the treatment of pulmonary contusion with a regimen that included analgesia, supplemental oxygen, strict maintenance of intravascular volume, CPAP, and tracheobronchial toilet.
Little has been written to indicate how therapy for flail chest may be different in the pediatric population.
Thoracic injuries consisted predominantly of pulmonary contusions, rib fractures, flail chests
and blunt cardiac injury, the incidence of pulmonary contusion being highest in the paediatric group.