What is True about Flail chest - and explain in detail?
Ans. is 'b' i.e., Paradoxical respiration on the side of flail o Flail chest is simply wrhen a portion of the bony chest wall loses its continuity from the remainder of the thorax due to multiple fractures.By definition, a flail chest occurs in the presence of two or more fractures in three or more consecutive ribs (either on one side of the chest or either side of the sternum) and causes instability of the chest wall; howrever, it can also occur after costochondral separation.o Flail chest is characterized by paradoxical motion of the chest wrall (inward with inspiration and outward with expiration ). The chance of having an intrathoracic injury in this situation increases severalfold.The paradoxical motion increases the work of breathing, and the most important consequence of flail chest is respiratory failure.o Until recently it was believed that ineffective air movement between both lungs caused by paradoxical motion of the chest wall was the main cause of the respiratory distress in patients with flail chest. It is now understood that underlying pulmonary contusion and pain during inspiration are the most important components in the pathophysiology of the respiratory failure.Management:o Patients without evidence of respiratory' distress can be managed with only analgesia. Pain control can be provided by an intercostal nerve block or more adequately by epidural anesthesia,o If respiratory distress develops, endotracheal intubation and mechanical ventilation with peak end-expiratory pressure are usually indicated, provided that pain control is adequate.