Treatment of a flail injury of the chest

Thoracic injuries present challenging problems in emergency medicine.During World War I, 20-30% of deaths on the battlefield resulted from these injuries.Crushing chest injuries commonly cause death in traffic and industrial accidents.About 25% of traffic accident fatalities are due to chest injuries.'In a review of 130 chest injuries at the Royal Newcastle Hospital, 29 patients had significant flail segments (22%).3These authors consider a flail segment one of the major indications for artificial ventilation in chest injury.In many cases, these patients require surgery in the immediate post-traumatic period, while the patient has some degree of respiratory failure.Understanding of the pathophysiology and treatment of flail chest, including a discussion of their historical development, is important for the anaest hetist. Case reportA 52-year-old, 80 kg man with major thoracic trauma after an automobile accident was brought to the emergency room.Physical examination revealed decreased breath sounds bilaterally with flail movement of the right chest and crepitations due to a large amount of subcutaneous air; the examiner also noted a firm