A 60-year-old man is in a car crash in which he is the driver. He did not have a seat belt or an airbag. He is found to have multiple rib fractures over his right chest. His pulse is weaker during inspiration. What are the most likely diagnoses?
Flail chest should be suspected in multiple rib fractures where the individual rib is divided in two places. Paradoxical movement results in lung compression as the flail segment moves inward during inspiration.
Flail chest
Empyema
Diaphragm rupture
Cervical rib
Trauma