How would you treat a flail chest?

Pain control plus...: Pain control is key...Depending on the level of associated lung injury, breathing support may be needed--noninvasive positive pressure ventilation (cpap or bipap mask) or intubation/mechanical ventilation. Surgery to stabilize the chest wall may be indicated, but this is controversial.

Pain control: Flail chest is generally treated with pain control to allow the patient to cough, deep breathe and clear any secretions. Pain control can be obtained with IV narcotics, oral narcotics, subcutaneous pain pumps or an epidural catheter. Recently, there has been increased interest in fixing the ribs with plates. The jury is still out on this but is appropriate in the right patient.

Surgery : Flail chest is usually best treated by surgery. I have a video online of this surgery - look on youtube for flail chest and drbentaylor.

Respiratory therapy: Flail chest is severe disruption of the chest wall. To provide enoughe oxygen, the patient must receive respiratory therapy. This includes deep breathing, coughing, chest pt, and pain control.

Flail chest tx: Flail segments reference a patch of ribs that are broken in two places each; the disconnected or flail segment can and does move opposite to the rest of the chest wall. Flail segments occur with significant trauma to the chest wall and are often associated with additional chest and lung injuries that are life threatening such as contusions and hemothorax, and pneumothorax.

Surgery: Evidence is mounting that fixing the ribs broken in a flail chest helps significantly. Pulmonary support is also key.