flail chest /flāl/ [ME, fleyl, whip; AS, cest, box] , a thorax in which there are two fractures on at least two adjacent ribs causing instability in part of the chest wall and paradoxic breathing, with the lung underlying the injured area contracting on inspiration and bulging on expiration. If it is uncorrected, hypoxia will result. ▪ OBSERVATIONS: Flail chest is characterized by sharp pain; uneven chest expansion; shallow, rapid respirations; and decreased breath sounds. Tachycardia and cyanosis may be present. Potential complications include atelectasis, pneumothorax, hemothorax, cardiac tamponade, shock, and respiratory arrest. Often other traumatic injuries are present in a patient with a flail chest. ▪ INTERVENTIONS: The treatment of choice is internal stabilization of the chest wall through the use of positive pressure. Bilevel positive pressure or mechanical ventilation may be used. If the patient breathes against the automatic ventilator, a sedative and muscle relaxant may be ordered to achieve ventilatory control. Chest tubes may be required to remove air or fluid that is preventing expansion of the affected lung, and a nasogastric tube may be ordered to provide food and fluids. The patient’s vital signs and breath sounds are frequently evaluated, and arterial blood gases are monitored. ▪ PATIENT CARE CONSIDERATIONS: The patient with flail chest usually requires a long period of care involving frequent repositioning, scrupulous attention to the patency and cleanliness of the tracheostomy or endotracheal tube, skin care, oral hygiene, pain management, and emotional support. Members of the health care team perform passive range-of-motion exercises involving the extremities, explain the various procedures, and provide a pad and pencil or a magic slate with which the patient can communicate.
