Treating Flail Chest: How To Recognize And Respond To This Serious Condition
Вставка
- Опубліковано 23 вер 2023
- In this video you will learn how to recognize and treat a flail chest injury!
_______________________________________
Skinny Medic Shirts
www.ballisticink.com/product-...
Civilian Medical Podcast:
firearmsradio.tv/civilian-med...
Patreon Support:
/ skinnymedic
Buy your medical supplies and kits here!:
medicalgearoutfitters.com/
In 2016 I was in a head on collision caused by a junkies. Amoung my numerous life threatening injuries was flail chest on my right side. All my ribs were broken off my sternum and my right lung was punctured and lacerated. I was in the progressive care unit for nine days while the doctors waited for me to stabilize, which didn't happen. After the 9th day I went to the o.r. Major surgery was done and four plates and 50 some odd screws were installed. My lower most rib has a 2ish inch piece missing so the right side of my rib cage is sprung outward a bit. My right pectoral muscle had been torn off my sternum as well, I lost about 70% of it. I was in the hospital for three weeks.
good grief. You surprise me by just surviving that!
Thoughts and prayers, I do t know you, but I’m glad you made it.
Jesus man. Glad your ok. We’re you on a motorcycle?
Goddamn dude. Glad you made through if and hopefully doing well these days
Oh wow, I'm so sorry and I hope you don't to much pain now a days.
🤯🤯🤯🤯 I've never seen that injury before.
Well now you have! 😉
Jet skis and other water events with speed is most often the environment where this happens.
Could obviously be from mvc, falls etc but jet skis are in my experience most likely involved.
Funny you should say that. We had an operator injured by a water ski, broke his ribs. He was back in the cab-over the following week when the tire directly beneath him exploded on the highway. Amazingly, he maintained control of the truck. Tough as nails, that guy.
@@deltabravo1811
Not gonna sit next to that guy on the bus.
I've heard of it but only in combat medical manual
When I went through paramedic training in the 70s, we were taught something completely different than which is stated here. If anyone has some tape, you can apply it to the frail area, and then fashion a loop like’ handle, and gently pull the chest outward and don’t let it fall inward. Do this until medics arrive. I’ve been on road accidents where this occurred back before shoulders restraints were integrated with seatbelts. I carry a roll of gorilla tape in my trunk along with my aid bag, as I never know when it might come in handy.
I was thinking that too . Maybe something like a big sticky rat trap in the location and wrap chest with duck tape . Or a piece of slightly flexible plexiglass and the sticky rat trap or traps in the affected area?
Yeah, my thoughts went that way... Maybe a few tongue depressors or indeed strips of something like plexi and a chestseal or AED pads to make an exterior splint...
Sure, you can do that, but it still doesn’t replace positive pressure and a good airway. If you were feeling creative you don’t even need to hold it per se with a loop, if you just keep a semi flexible aluminum splint, bridge it, and tape it on each side plus a piece of tape over the flail segment.
That's smart.
Thats the first thing I thought of,with maybe some sort of improvised rigid frame to keep it held out.
Many years ago I was taught you put pressure on it with a bulky dressing to keep it from moving. Glad to know the updated treatment. Thanks.
I’m glad you made a response to this video. I’ve seen it making it’s way around and wanted a paramedics thoughts on it 👍
Never saw anything like that before! Thanks for explaining it! ( I hope I never actaully see it, either!)
Hopefully!
Holy Mackeral! I've never seen this injury before or even heard of it, but as soon as I saw that poor dude trying to breathe, I knew there was a serious problem. I hope I never encounter this injury IRL. I would imagine that without immediate medical care that's going to result in the expiration of the injured party pretty quickly.
Excellent video, short and packed with information the average man can understand. Absolutely outstanding.
Thank you! Definitely good to know what this is. I could easily see someone freeking out seeing this.
I love this kind of video. Shocking video with an explanation of what it is and how to treat. Awesome.
I've never heard of this type of injury. Thanks for posting it.
If you take enough injury to break a few ribs in more than one place you tend not not live through it, sadly.
It is kind of the same logic why TBI is so much more common now, we now have the safety gear that permits people to live through things that use to kill them and thus they live through motorcycle and auto accidents and IEDs that a while ago would have been fatal. And much of that difference was made because the brainpan was so much more protected by helmets, airbags and the like.
With ribs we really are not to that point yet. I mean yeah you are likely to get a few broke ribs in a car accident, but they tend to be single breaks. And if the accident is enough to give you more you really do not have good odds of living through it long enough to show off the more obscure injury types. The odds are better today for sure, but still not all that great.
Wow. Never knew about this condition. That video was shocking.
Thanks for showing and explaining, do more vids like this
Thanks, will do!
thanks for the heads up. I'd never heard that term before. you can never know too much. good to see you !
What an excellent video! I had never heard of this before. Thak you!
I thought I knew a lot about injuries and the body, but not THIS ! I've never heard of it before ... thank you so much much for this video!
Always loved this channel.
subscribed brother
I'm schooling to be an emt....just covered this stuff. Nice.
Nice!
Thanks for an excellent educational video. I can only imagine what force it would take to break that many ribs to get that kind of movement of the chest cavity. Ouch! Carry On Sir!
Supposedly it's usually cause from a jet ski etc, fast watersports. Run overs.
Excellent video thank you! We need all learn these things now. What's the best way to sit the patient or lay the person.
Outstanding info!
Thank you!
It’s really amazing someone in the group there thought to pull out their phone and record.
Thank you! Subscribed!!
Thanks for the content !
🇺🇸
Thank you for the support!
Appreciate the videos
Never heard of this, but makes so much sense. Thinking older folks are going to be more susceptible to such breaks in falls or accidents. I wonder how common this would be in falling off a horse. I've seen some bad falls in jumping with horses, as sometimes a horse will even roll over a person. Some of those big jumping horses in speed events like eventing can really fling you - going 25 mph from 6 feet up tossing into jump material (poles) & then horse falling / rolling over on person. I'd think that might cause this breakage. Scary!
Wow. Good video. Thanks
Good content,thnx.
Almost 30 years old and I’ve never even heard of this wow. Thank you sir
great video
Great vid good info scary stuff.
I’ve never heard of this before. That footage was wild.
Thanks for the video 👍 Never heard of this injury before 😬 Would love to know if there is anything that can be done if EMS is going to be a long wait.
Same here!, 👍
I think he mentioned there's not much, light support if possible to keep things from moving to much.. really a tuff case.
There's a comment from DanOrtegoUSA down below, talking about tape and creating a handle to keep it from collapsing. Worth a look.
Very good. . Thank you.
Thank You.
Thats definitely a surgical injury... it's gonna need intrusive trauma surgery and internal splinting immediately. If this happens and there's no hospitals available, the person is not "likely to", but is GOING TO have pneumonic supparation and septic lung, not to mention hypoxic shock. It needs to be treated by a trauma surgeon (aka orthopedic surgeon) IMMEDIATELY.
This injury is often seen after soft body armor does it's job right, and is absolutely life threatening. It's also seen in streetfights.
That's what I know from the internet and personal experience.
Thanks for the video, it's great to see it from the other side so that you can know how to handle it.
So I'm super glad I bought hard composite body armor.
@@HumorDash AR-500 is best, but composite armor is good for a couple hits... it's the cavitation and backside deformation that creates this injury.
Dang...That's a rough one. Thank you. Im going to discuss this with my co-workers.
I had 4 broken ribs. I was in a medical coma for so long that by the time I opened my eyes I never felt any pain with my ribs.
1987 I wrecked a truck, rolled it 360 degrees, hell of a ride. Well I pulled a rib loose, it’s still loose will be until I die. Got 2 weeks off work & then went back to work, lived to tell the tale. It was a while that I had to sleep on the other side. I’m used to it now.
Thank you Sir for the video
In keeping with the field possibilities , could or would supplement breathing (mouth to mouth or a patient regulated positive air supply) alleviate some discomfort ?
Thanks for sharing .
Good video.
January 9, 2014 I was in a motorcycle accident. 9 rib fractures, all on right side., shattered clavicle, shoulder fracture, flail chest, knee fracture, head injury. 21 days in ICU on a vent. This video gives me PTSD.
Love the Highpoint in the back😂
Dear sweet Jesus that video at the beginning, never heard of this before but honestly if I saw that it’d be ambulance immediately.
Holy shit! That looks like a nasty injury. Not mention the pain! Thank you for posting.
The crazy part is dude didnt appear to be in a tremendous amount of pain. He was talking and pointing at the injured area. That was hard to watch, I have never heard of that one.
Thanks for this video. My first aid training only touched on this very briefly - told to put slight pressure by bandaging it loosely. Would you put the casualty with the injury beneath them to restrict the paradoxical breathing movement (if they could tolerate the pain) or would this cause more pain & increase the likelihood of a lung tear on a sharp piece of smashed rib?
They had to reconstruct 6 ribs with about 17 fractured (some front, most back) within two days of my cycling accident (no car - they think I passed out and crashed). Multiple titanium plates and screws, but my life is back to normal. I’m back to running, triathlon, etc. But for 2 days I was catastrophically injured.
Holy schit! I never seen anything like that until now
I never knew such a thing existed!
Scary!
That video scared the crap out of me. I know that poor man must be in terrible pain
Oh my God that is gnarly looking. My God that's sad hope that persons all good.
Great video thanks from Sc
I’m in a hospital now behind a lung operation. Two ribs broken and glued back in with reinforcement plates. Rough. This hits right on your video thanks again from. Sc
Flail is an evil weapon, seeing the injury is testament to it. Wish you gave more information please.
Oh, I have not seen this injury before. Very bad day indeed. Wow!😔
YT recommended this video to me and I've never seen anything like 0:34 in my life. That doesn't even look real. 😱 Glad to have learned what I did thanks to your video, but I hope I never experience that and I hope I never see anyone else experiencing it.
I would like to know more about how to treat for it in an emergency situation where it must be done primitive and kept long-term for healing.
Yikes! Thank you..
Question: If professional medical treatment won't be available for an extended time, can this injury be splinted from the outside by bonding the skin to something rigid using super glue? (a piece of wood or plastic - anything to keep the tissue from caving in during inhale.)
That won’t really work for several reasons. One it would be too much of a moving target for the adhesive to dry, two the negative pressure created over several breaths would break free. And lastly that is a lot of equipment that you just won’t have. Your best bet is to prevent a full expansion of the segment away from the chest wall to reduce to motion of the swing. Unfortunately aside from surgery and PAP you won’t be able to do a lot for these.
There are some pretty strong adhesives out there today - after seeing the clip in this video I wondered the same thing. Like, some surgical tape and a few strong sticks could be used to fab a rigid pad to keep the area from sucking in as the patient inhales.
Why not superglue + activator? That stuff bonds everything, including skin, instantaneously. Hypothetically, lets say we had a glue that worked. Would that be a sufficient splint?
Just thinking out loud... maybe a bonded splint causes more harm than good if a surgeon can't remove it to make a surgical repair?
@@jdecar1 surgeon can remove anyting and you don't have a whole lot of planning available when you have this I haven't seen a flail chest get an emergency first-aid
I know about sucking wounds and collapsed lungs, but this is the first time I've seen a flail chest.
Never heard of such a thing but that looks terrifying.
So in a Cascadia Earthquake scenario there really isn't much we can do for people with this sort of injury? I ask because as cold as it sounds, I wonder if this sort of this is something I shouldn't waste time on and instead should focus on those I actually can help.
I like your question... thinking triage... It always depends on what resources you have available, so Idk... 🤷 maybe learn first aid, and chemistry, to give you an edge? 😉
If you don't have the ability to provide positive pressure ventilations via BVM (preferably with O2), there is not much a first responder can do besides place them in position of max comfort, and provide O2 if you have it. It takes a great deal of force to produce a flail chest, so they are often unstable to begin with, or become unstable as sharp edges of the free floating ribs may lacerate the lung, leading to a pneumo-, hemo-, or hemopneumothorax, and/or lacerate other internal organs.
Ok this is probably dumb, but my first thought was figuring out a way to glue something to the section moving in and you could hold onto it and keep it from moving while the person breathes, like a flat piece of plastic and a crapload of superglue then have one of those suction cup handles stuck to the plastic and be able to hold onto it while they breath. Only thing is i dont know how well the skin is attached to the ribs , would that keep the ribs from moving or just hold the skin in place?
My wife suffered this injury last year. All the ribs on her left and 3 on the left.
Good to get recognition of the injury but in a situation with no help soon some sort of approach to mitigate and support breathing would be appreciated.
What is the best treatment in a backcountry situation?
It's also called "Paradoxical-breathing". It's also excruciating. The body doesn't get enough Oxygen, so it speeds up mechanical breathing of a busted ribcage. As an EMT, the correct action is maximum O2, then 'pack' the dent and bind it.
That’s crazy 😮
Former Army Medic here and the best we were able to do was get those large abdominal dressing to at give a remedy
Ouch!
Ouch.
What does it mean to splint it from the inside?
Hey man, no questions asked ok?
I have not eaten any food in 4 days, starting 5 tomorrow. What are my major concerns when I start to eat?
I got some cognitive issues, not spelling right, actually never had dyslexia but typed 4473 as 7743 today lol. I didn't realize it unti l I reread everything. I read a little about refeeding syndrome but not sure that'd apply.
Hydration is first key, I haven't fasted that long but had no worries starting on anything if it was by choice. Bonebroth is a good start too
But will the VA consider this an emergency?
I'm thinking that guy isn't thinking what a great example. Thank you
I had a seperated sternum once. Wow that hurt.
How did that happened to you? Did it have any visible signs of the sternum being separeted?
@@Robytsu Back in the early 80s an old car I was driving skidded through a guardrail and off a bridge approach. I was a PO back then on my way to work. When I saw the ground coming up I had just enough time to cut ignition and twist my legs away. That saved them when the firewall buckled. At the time very luckily I was wearing a 2nd Chance level II soft body armor. The front end of the car collapsed but it had the old type steering column that doesn't collapse. Basically it pinned me like a butterfly or tried to. Hit my chest hard enough to break the seat back. I am of the opinion having the seat belt on made no real difference in that instance. I was cut out of the car and had windshield glass in my forehead, but since I wasn't in a position or shape to take my shirt off and my vest too, I don't know what it looked like when they cut those off later. They didn't let me sit up in the ER, I just saw ceiling and various people looking down at me and doing stuff. I just knew my chest and breathing hurt like hell. Got some morphine in the ER and went to sleep. I moved really slowly and had huge bruises for awhile afterwards, Took decades for the last of the glass to work it's way out of my scalp.
Omgosh!
When recommending positive pressure, I would imagine pneumothorax exists in at least a healthy percentage of flail chest injuries, how do we mitigate filling the plural space with air?
I’m thinking a stop cock/decompression set up or a chest tube if indicated. Have not had to deal with this enough to have a protocol. What are your thoughts?
You know you've seen too many decapitations with dull blades when this is considered more horrific.
That happened to me but not as severe. broke a few ribs right near the spine, they still seem to be a little fucked up.
Would taping a sectiion of a splint so the chest would adhere to the splint work?
That's gonna be a hellish thing to try and treat without hospitals in a shtf collapse. I wonder how they did it in the old days before modern medicine. Probably drill dead centre, insert like a small T shape of right angle hook through to pull the ribs into position and fix it to a rigid body formed harness with screws or a torsion/tension skein. I'm not a surgeon or read this. It's just an idea. The ribs would heal and the body can fight infection with or without meds.
Sorry, I didn't clearly get what do we need to do in this case until EMT arrives...
For a first response, I would use copious amounts of super glue with activator for immediate polymerization and/or a strong adhesive with wire mesh embedded, to prevent the structure from collapsing or expanding when breathing, possibly with some extra support, rigid of course. What do you all think?
Some kind of glued on support was also my first thought. Having it hand and having something that doesn‘t need excessive force later on would be 2 issues to solve first. Both tricky as first responder.
@@pan6593 Most adhesives can be removed with acetone, that'd be easy, and I've also seen products that can remove cyanoacrylate too. As I said already, with a wire mesh, this type of support would at least prevent further lacerations caused by the broken bones. Local anesthesia may also help the person breath, provided there isn't a perforated lung/pleura and/or a fluid build up, but that could be aspirated easily after the application of the support. Personally, for first responders/paramedics, I think that this would do the job, giving them the time required to reach the hospital, which is most likely the mandatory next stop, unless it's a battle field.
How do you splint from the inside out???
So what are you supposed to do in that situation? Just put pressure so it doesn’t move in and out? Cause I feel like that could raise the risk of a puncture
How Would a decompression needle effect this injury?
It wouldn't. The problem isn't air in the wrong spot, it's the complete failure of the structural integrity of the ribcage.
You know what's f'd up, that's f'd up!
Maaaaaan I didnt need to see that. Super interesting, but like watching a train wreck in slow motion
can someone elaborate the "splinting/split it from the inside out"
Maybe double stick tape on the splint.
How can you splint from the inside out???
Why not tape it so it doesn't sink?
What about getting a wad of duct tape right on the section that collapses and you hold one end of it to keep the chest it from flailing?
Could duct tape be stuck to a large area over the woods to keep the middle broken pieces of the ribs from collapsing back into the victim?
Good idea but I am not sure it would be very effective.
Thank you!
The terminology is quite interesting! Based on historical accuracy for the destruction caused by a flail striking your side!
I have a background in medicine, martial arts, and military.
Knowing how to kill goes hand-in-hand with knowing how to treat/cure.
New one on me!
Splinting from the inside sounds a lot like a Large device modeled after a TOGGLE BOLT...
Scary as hell. MORE scary than hell. Emergency.
Nice yeet cannon you have there.
Damn. New fear unlocked.