Steering wheel injury on chest of a young man reveals multiple fractures of ribs and paradoxical movement with severe respiratory distress. X-ray shows pulmonary contusion on right side without pneumothorax. What is the initial tretment of choice ?
The initial treatment of choice for flail chest presenting with paradoxical respiration is endotracheal intubation and ventillator suppo with IPPV(intermittent positive pressure ventillation).Assisted ventilation is required for several days until the chest wall stabilises.If ventilator suppo is needed for more than 10 days,then tracheotomy is done to prevent laryngeal stenosis which can occur due to prolonged endotracheal intubation. Reference:SRB's manual of surgery,5th edition,page no:1116.
Immediate internal fixation
Endotracheal intubation and mechanical ventilation
Thoracic epidural analgesia and O2 therapy
Stabilization with towel clips
Cardio thoracic surgery  