Figure 3-9. Sling and swathe applied to a casualty with a fractured rib.
Do not tape, strap, or bind the chest since these actions could interfere
with the casualty's breathing. The swathe should not be tight enough
to compress the casualty's chest.
b. Monitor and Evacuate Casualty. Monitor the casualty's breathing.
Encourage the casualty to take deep breaths to inflate his lungs. If the casualty has
difficulty breathing, establish and maintain an open airway. Administer oxygen if it is
needed and is available. Observe the casualty for signs and symptoms of tension
pneumothorax and hemothorax. Evacuate the casualty when possible.
3-17. CHECK FOR A FLAIL CHEST
A flail chest results when three or more ribs are broken in two or more places,
allowing rib segments to "float" (figure 3-10). The sternum may also be fractured.
Floating rib segments may damage a lung, major blood vessels, or the heart. Lung
tissue lying under the flail segment is usually damaged, resulting in internal bleeding
and swelling which interferes with respiratory function.
a. The floating rib segments do not follow the normal chest movements. Their
movement is paradoxical (opposite normal) in that the floating rib segments move in
when the casualty inhales and out when the casualty exhales.
b. Other indications of a flail chest include a lack of lung expansion resulting in
loss of effective lung volume. The casualty usually tries to breathe deeply to offset the
decrease in lung efficiency. Severe hypoxia and cyanosis can occur quickly in spite of
the casualty's efforts.