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Severe shortness of breath and paradoxical chest movement are key indicators of flail chest due to the nature of the injury. Flail chest occurs when multiple adjacent ribs are fractured in multiple places, leading to a segment of the chest wall that moves independently from the rest of the thoracic cage. This results in the paradoxical movement where the injured section of the chest wall behaves contrary to normal inhalation and exhalation: it paradoxically sinks inwards during inhalation and bulges outward during exhalation.

Severe shortness of breath is also typical, as the compromised stability and mechanics of the chest wall can severely impair normal respiratory function, causing inadequate ventilation and oxygenation. This condition often necessitates immediate medical intervention to stabilize the chest wall and support respiratory function. The other symptoms, while they may occur in various medical conditions, do not specifically correlate with the classic presentation of flail chest.