Flail chest with coagulopathy causes high mortality aggravated by acidosis and hypothermia


  • Dedy Chandra Hariyono Surgery Resident of Sebelas Maret University, Surakarta, Indonesia
  • Darmawan Ismail Department of Thoracic and Cardiovascular Surgery Dr. Moewardi Regional General Hospital, Surakarta, Central Java, Indonesia
  • Azzahra Fadhlila Aulia Nisa Department of Clinical Medical Student, Dr. Moewardi Regional General Hospital, Surakarta, Central Java, Indonesia




Flail chest, Hypothermia, Coagulopathy, Acidosis, Trauma, Mortality


Flail chest is a condition where the ribs are broken in 2 or more places in successive ribs. The most common cause is blunt force trauma due to motorcycle accidents, falls or other conditions of bone abnormalities (congenital abnormalities, bone fragility) in young children or the elderly. This flail chest condition causes paradoxical movement of the chest when breathing. In line with the different breathing movements (moving inwards on inspiration and moving outward on expiration) this fracture compartment of the bone can injure the surrounding tissues which can cause complications such as pulmonary contusion with coagulopathy, inadequate ventilation which causes hypoxemia, and hypoventilation which causes acidosis due to reduced oxygenation of the tissues. Flail chest can also cause bleeding which ends in hypoperfusion causing hypothermia which will exacerbate coagulopathy. Flail chest is an important thing that needs to be assessed early after trauma so that no bad complications occur that lead to the triad of death (coagulopathy, acidosis, and hypothermia). Flail chest is an emergency condition frequently caused by blunt thoracic trauma. If it develops to pulmonary contusion it will lead to fatal condition implicates triad of death especially coagulopathy impaired by acidosis and hypothermia.


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