A 50-year-old man sustains blunt chest trauma. There is paradoxical inward movement of a segment of the right anterior chest wall during inspiration. He is alert, respiratory rate 26/min, SpO2 93% on face mask oxygen, and breath sounds are present bilaterally. What is the most appropriate initial management?
- A Multimodal analgesia including regional blockade with supplemental oxygen and physiotherapy ✓
- B Aggressive fluid resuscitation to improve chest wall mechanics
- C Immediate endotracheal intubation and mechanical ventilation
- D Strapping of the flail segment with adhesive tape
Correct answer: A. Multimodal analgesia including regional blockade with supplemental oxygen and physiotherapy
Explanation
The physiological problem in flail chest is pain-induced hypoventilation and underlying pulmonary contusion, not the paradoxical motion itself. In a patient without ventilatory failure, the correct initial treatment is effective analgesia (intercostal or epidural blocks, systemic opioids), oxygen, and chest physiotherapy. Intubation and ventilation are reserved for respiratory failure or shock. Strapping is obsolete because it restricts chest expansion and worsens atelectasis.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.