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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