A 45-year-old man sustains blunt chest trauma with four or more adjacent ribs each fractured in two places, producing a paradoxical moving segment of chest wall. He is breathing spontaneously with saturations of 92% on 5 L oxygen. Beyond supporting ventilation, the single intervention with the greatest impact on outcome is:

• A Strapping or binding of the flail segment with adhesive tape
• B Early operative fixation of the rib fractures in all patients
• C Aggressive thoracic epidural analgesia to enable deep breathing ✓
• D Prophylactic antibiotics to prevent pneumonia

Explanation

The morbidity of flail chest comes less from the unstable chest wall than from the underlying pulmonary contusion and from splinting due to pain, which impairs clearance of secretions and causes atelectasis. Effective regional analgesia, ideally thoracic epidural, allows deep breathing and physiotherapy and reduces ventilator days and pneumonia. Strapping paradoxically restricts ventilation and is obsolete. Operative fixation benefits selected severe cases but is not universal, and antibiotics are not routine prophylaxis here.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.