This is a BLS question. For management of a flail chest, most research suggests that we tape the flail segment in place with a large bulky dressing, bag of saline, Asherman chest seal, etc. I've been hearing from recent PCP graduates that they have been taught to use a bulky dressing, however they mention that they are being taught to do a circumferential wrap around the chest with a triangular bandage or blanket to hold the dressing in place (which I would assume is incorrect) instead of taping a bulky dressing over the flail segment. What would be the preferred method and why?

SWORBHP Medical Council is not prescriptive on this management. A bag of saline can be positioned over the flail segment to assist with splinting. This splinting will assist with analgesia as well as physiology of breathing. How it is affixed will depend on your available resources, the patients condition and injuries etc. However you choose to affix the dressing, make sure that the patient can still take effective ventilations. Also, ensure you are able to properly clinically reassess the patient regularly, as their condition can change quickly, from this as well as other traumatic injuries.

Your technique and approach may change depending on the location and size of the flail segment, the number of casualties and resources you have and your transport time. Clearly you have some great approaches and ideas to assist stabilizing the chest.

Lee C, Revell M, Porter K, Steyn R; Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Emerg Med J. 2007 Mar;24(3):220-4. doi: 10.1136/emj.2006.043687. PMID: 17351237; PMCID: PMC2660039.

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Trauma

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