How would Physical Exertion Affect a Flail Chest?

[Aryon]

Hello everyone.

I'm a writer who is currently working on a Sci-fi novel that deals heavily with military combat. During one scene in this novel there's squad leader who sustains a sever chest injury which causes several parts of her rib cage to break. Now, this squad leader insists on pressing on with her mission despite the injury, (and takes some very powerful numbing agents to deal with the pain.)

So my questions are, aside from the pain element, what would the effects of flail chest be on someone who continues to exert themselves? Would this eventually cause her to lose consciousness? If that is the case how long would she have?

 

[berkeman]

What research have you done on flail chest injuries so far? What is the main danger from a flail chest injury? We prefer that you show some effort of your own before we chime in. Thanks.

BTW -- We do have a SciFi writing forum here at the PF, but this is mostly a medical question, so we'll leave your thread in the medical forum for now.

 

[berkeman]

Also, what is the field treatment for a flail chest? How much does that mitigate the danger for the more serious complications?

 

[Aryon]

What research have you done on flail chest injuries so far? What is the main danger from a flail chest injury? We prefer that you show some effort of your own before we chime in. Thanks.

BTW -- We do have a SciFi writing forum here at the PF, but this is mostly a medical question, so we'll leave your thread in the medical forum for now.

What I know so far is that Flail Chest is caused when two or more of the ribs break off from the rest of the ribcage and start moving separately from the rest of the body when the victim breaths. This would normally cause sever pain (which in this case is mitigated by drugs), but if left untreated would eventually lead to those broken ribs puncturing the lungs which in turn would lead to respiratory failure.

What I'm having trouble finding out are how these conditions would be effected when the victim then goes under immense physical exertion with this condition. In the context of the novel, this character would continue to run while carrying about ninety pounds of equipment, and also gets into a firefight while she has this injury.

 

[jedishrfu]

Wikipedia has an article on the injury

https://en.m.wikipedia.org/wiki/Flail_chest

 

[jedishrfu]

It mentions bruising of the lungs and so it’s possible that the lung could get punctured from the stress and internal bleeding could result too. Not sure about septic shock which would come from an infection, bullet wound, shrapnel...

https://en.m.wikipedia.org/wiki/Septic_shock

 

[berkeman]

So that's close to what the dangers are from a flail chest (beyond the extreme pain -- do not ask me how I know this). Can you post links to the reading you've been doing about this?

And there are at least two serious medical complications from broken ribs, especially the more extreme version of the flail chest. Puncturing the lungs is one, with the associated significant reduction of lung function (followed by LOC and death), and severed blood vessels (followed by significant blood loss, hemothorax, LOC and death).

You didn't comment on the field treatment (Tx) yet for flail chest. What have you found in your research so far? How would that Tx not be real consistent with continuing to fight? Can you think of variations on that field Tx that might enable a soldier to keep fighting with pain meds on board?

 

[Fervent Freyja]

Do a real life experiment to get an idea of the pain and physical difficulties she might face.

Take two 40 pound 5 year olds for a walk to the park, then incite a tantrum in each of them before you head back, that way, you have to physically walk them back, each one on a hip.

The tantrums can subsititue for the firefight, as their legs and arms are likely to be flailing about and knocking you everywhere!

The wailing and crying is also a good replacement for the distracting sounds of a firefight/battle.

Oh, and in addition, there is a 2 year old in the stroller that you are having to push with with your foot and keep on track with your free fists, it could substitute the respiratory effects of running with a flail chest (causing a frequent pause in the walk). I went through all this once and it burned in my memory, having to drag them in that monstrous state (in front of traffic and everything). I haven't taken the 3 of them for a walk to the park together since!

At first I read this and thought it was not possible. But, actually, this could be done in real life, as long as your character does not experience a lung being punctured until near the end, then totally doable.

 

[schpier]

Since this is a novel, you have the freedom to make the character succeed or fail in whatever role you cast her. All previous comments are valid. (Critical care physician).

 

[Laroxe]

A flail chest only tends to occur as a result of blunt trauma and depending on the size of the area effected, the way in which the bone is deformed and adjacent structures can be immediately life threatening. Even with pain killers few people would feel like wanting to exert themselves as well as pain, it significantly impairs breathing and there will be varying degrees of blood loss, exertion would increase this blood loss and breathing problems. I think for any significant injury of this sort such actions would be impossible, a few broken ribs with bone displacement could kill in such a situation, if it were possible, they would be useless in a fight, she would even need to insist on carrying on very quietly, its unlikely she could shout orders.
Tightly strapping the chest with an adhesive dressing/bandage to the skin might possibly give sufficient fixation of the area to reduce some of the risks for a short while.

 

[Steelwolf]

The standard treatment of taping the ribs and bandaging into place is a very common one, the danger of the ribs moving about and causing more tears under movement is the biggest danger. Having had broken ribs, and a broken collar bone at one time I can say that, yes, you Can get up and keep moving, but it is NOT going to be moving fast, Not carrying anything aside from personal weapon and shouting is certainly out. The individual would slow down the whole team greatly. Now combat is one of those times where it does not matter what has happened to you, if you still have life, you still fight, but once the immediate fighting stops, you are back to trying to survive in the boredom and not gain attention. But in a case like major opened ribs or breaks, the person themself usually has to make the decision to move or not, usually they know they cannot move at speed, nor carry their gear. Sp usually and Often a badly injured person is evac'ed or left behind with a signaling device to get assistance once the main team has moved away. In severe situations behind enemy lines they may be left with allies to recuperate, or left a small camp with radio, or if nothing else, left a pistol with a single clip or a single grenade so as to remove them from possibly being questioned if captured, as would seem likely with injured personnel Depends on the story line though

The character could be going along just fine, and suddenly fall over dead too with undetected bleed or puncture that fills the thorax with blood or air, not allowing lungs to work. Which is why chest wounds are almost always evacced.

Bad situation to be in