MEDizzy - A 31-year-old man is brought to the ER following an

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Trauma II

A 31-year-old man is brought to the ER following an automobile accident in which his chest struck the steering wheel. Examination reveals stable vital signs and no evidence of respiratory distress, but the patient exhibits multiple palpable rib fractures and paradoxical movement of the right side of the chest. Chest x-ray shows no evidence of pneumothorax or hemothorax. Which of the following is the most appropriate initial management of this patient?

ExplanationD. Management of flail chest consists of adequate analgesia, chest physiotherapy, and mechanical ventilation if respiratory compromise develops. Flail chest is diagnosed in the presence of paradoxical respiratory movement in a portion of the chest wall. At least 2 fractures in each of 3 adjacent rib or costal cartilages are required to produce this condition. The complications of flail chest are no longer believed to arise from this paradoxical motion, but rather the underlying pulmonary parenchymal injury with resultant hypoventilation can lead to atelectasis, pneumonia, and respiratory failure. Indications for mechanical ventilation include significant impedance to ventilation by the flail segment, large pulmonary contusion, an uncooperative patient (eg, owing to head injury), general anesthesia for another indication, and the development of respiratory failure. Chest stabilization with sandbags or towel clips is no longer used. Surgical stabilization is performed only if thoracotomy is to be performed for another indication.