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First Aid for Flail Chest

By Bill, posted
Flail chest is a potentially life threatening condition which occurs when three or more of the ribs are broken. The broken segment can then detach from the normal breathing process and at worst cause the underlying lung to fail. Quick thinking first aid skills can stabilize the casualty until professional help arrives. 

Causes


The number one cause of flail chest injuries is through car / motor vehicle accidents, which includes seat belt trauma at impact. In these instances the condition can be complicated when casualties are trapped within the vehicle.

Other known causes are the elderly who are more vulnerable to flail chest when falling. Also any high impact sport can break several ribs, subsequently causing a flail chest. 

Symptoms


The most common chest injury is to break 1-2 rib segments, whereby the ribs remain attached to the chest wall. Casualties will be in serious pain and will have mild breathing difficulty. 

Flail chest is slightly different whereby the casualty will be in extreme pain and experience severe breathing difficulties. Look out for the following signs and symptoms:
  • Shallow breathing as the condition deteriorates
  • When examining the lung the detached segment can fall away when the casualty breathes in and move outwards when they exhale
  • High levels of pain
  • Unconsciousness or non-breathing
Helpful hint - Ask the casualty what the pain feels like on a scale of 1-10. It would be common for a 9 -10 to be reported with flail chest

Treatment 


Flail chest requires emergency medical treatment in case the broken segment places undue stress on the lungs, heart and other surrounding tissues. For this reason it is important to dial 999 / 112 stating your location and the nature of the injury. 

Unfortunately the first aider will only be able to prevent the condition from worsening until help arrives. The best way to do this is to assist the casualty into a sitting position, leaning towards the injured side. Use a pillow or other similar object to place under the arm, with some pressure on the flail segment. This can help stabilize the affected area which is known to reduce the chances of underlying damage.

If the casualty is unconscious lie them in the recovery position on the affected side down, which will help minimise movement from the flail segment.

The worst case scenario is that cardiac arrest will occur through the underlying damage to the lung. In this case report the information to 999 / 112 and immediately start Cardio Pulmonary Resuscitation (CPR). This should continue until medical professionals tell you to stop, or the casualty shows signs of normal breathing.

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