Flail Chest

Flail Chest



Basic Information image



Definition


Three or more consecutive fractured ribs, allowing a section of the rib cage to float freely



Synonym(s)


Multiple rib fractures



Epidemiology



Species, Age, Sex




• Rare in adult horses because of the magnitude of force required to fracture multiple ribs


• Foals may develop a flail segment secondary to rib fractures sustained in parturition.


• Flail chest is rare in foals; rib fractures are usually singular (one per rib).



Associated Conditions and Disorders




• Pneumothorax


• Pneumomediastinum


• Hemothorax


• Pulmonary contusions


• Pleuritis


• Cardiac contusions



Clinical Presentation



History, Chief Complaint




• History


image Trauma (eg, hit by car)

image Dystocia

image Thoracic wounds

• Chief complaint: Increased respiratory rate and effort



Physical Exam Findings




• Paradoxical movement of the flail segment


image In with inspiration

image Out with expiration

• Tachypnea, dyspnea


• Tachycardia, arrhythmias


• Circulatory compromise (pale mucous membranes, cool extremities, poor pulse quality)


• Crepitus or depression at the site of the fractures


• Wounds or other injuries related to the inciting cause



Etiology and Pathophysiology




• Fractured ribs are caused by trauma (external blunt force, penetrating injuries) or compression because of abnormal presentation during parturition.


• Respiratory dysfunction is likely caused by a pulmonary contusion, pneumothorax, or pleural effusion secondary to the initiating trauma rather than the flail segment itself.


• Pulmonary trauma results in atelectasis, edema, and hypoventilation, which results in hypoxemia through decreased diffusion of oxygen and ventilation-perfusion mismatching.


• Pain amplifies hypoxia through decreased tidal volume and hypoventilation.

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Flail Chest

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