Industrial accidents are not an unusual admission to the Christiaan Barnard Memorial Hospital ER. After a patient was crushed between two machines in the work place, extricated with the help of paramedics and rushed to the ER, it was found that he presented with a flail chest, a haemothorax and a liver laceration.
A Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. |
A Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma. Most haemothoraces are the result of rib fractures, lung parenchymal and minor venous injuries, and as such are self-limiting. The blood accumulated in the pleural space results in the collapse of the associated lung. |
Feliciano DV. Surgery for liver trauma. Surg Clin North Am. 1989;69:273–84
The effect of a flail chest on breathing...
For a person to draw a breath, the muscles around the rib cage and the diaphragm have to move to expand the chest cavity. This creates a vacuum that is filled as air enters the lungs. If this expansion is hindered, the ability to draw air into the lungs is diminished. Due to a flail segment, the chest cannot expand properly and cannot properly draw air into the lungs. |
The patient required urgent intervention, including the insertion of a chest drain in the ER, allowing for the accumulated blood to drain and the affected lung to expand. Along with adequate analgesia, the patient was then sent to the ICU for further management and further diagnostics.
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OHSA: Common Workplace Violations
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