(4) Crepitus (grating sounds; sounds which can be heard when bones move
against each other).
Subcutaneous emphysema (a condition to be discussed later).
d. Associated Complications.
(1) Rupture or lacerations of underlying structures are common. If there is a
direct blow to one or more ribs, there is a possibility that the rib ends may be driven into
the lung underneath and the pleura, causing damage.
Internal bleeding may be caused by fractured ribs.
e. Treatment. Treatment includes examining the casualty for underlying chest
problems and giving him something for pain.
A flail chest occurs when two or more adjacent ribs are fractured in two or more
places resulting in a segment of the thoracic cage becoming detached. Flail chest--also
called floating or crushed chest--is more common in today's era of high-speed
automobile accidents. It is usually caused by a blunt blow to the ribs. If two or more
ribs are broken in two places, the part of the chest wall between the breaks collapses
and does not participate in the normal expansion of the chest each time the person
inhales. When the casualty exhales, the part of the chest wall between the breaks will
protrude while the rest of the chest wall contracts.
Figure 1-1. Flail chest--paradoxical respirations (active breathing).