A 40-year-old man sustains blunt chest trauma with fractures of ribs 4 to 7 on the right in two places each. He has a flail segment with paradoxical movement, respiratory rate 26/min, SpO2 93% on oxygen, and is haemodynamically stable without worsening gas exchange. The single most important intervention in his initial management is:

• A Immediate mechanical ventilation with positive pressure
• B Strapping of the chest wall to stabilise the flail segment
• C Operative fixation of the fractured ribs
• D Aggressive multimodal analgesia including regional blockade ✓

Explanation

The morbidity of flail chest comes mainly from underlying pulmonary contusion and pain-limited breathing causing atelectasis and pneumonia. The cornerstone of management is aggressive analgesia, ideally with epidural or regional nerve blocks, which restores ventilation and clears secretions. Intubation is reserved for respiratory failure, not prophylactically in a stable patient. Surgical rib fixation is considered selectively for refractory cases or severe displacement, and chest strapping worsens hypoventilation and is obsolete.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.