A 35-year-old man met with a car accident in which his chest struck the steering wheel of his car. He is brought to the emergency with stable vital signs and no respiratory distress but multiple rib fractures are palpable and right side of the chest shows paradoxical movement. Chest x-ray rules out any pneumothorax or hemothorax. What is the most appropriate initial management in this case?
This is likely a case of flail chest. It is caused by - Fracture of 2 or > 2 consecutive ribs at 2 or > 2 places Clinical features: Paradoxical Respiration (fractured pa move opposite than rest of the chest) Voluntary splinting due to pain |se risk of respiratory failure Mechanically impaired chest wall movement It is a clinical diagnosis by observe the patient for paradoxical motion of chest wall segment Treatment: O2 administration + adequate analgesia (epidural analgesia) + Physiotherapy If respiratory failure present - Intermittent positive pressure ventilation (IPPV)
Analgesia, chest physiotherapy, & observation
Intubation & mechanical ventilation
Stabilization of the chest wall
Immediate operative stabilization
Trauma