A 50-year-old man sustains a lateral impact road traffic accident. He has paradoxical movement of a segment of the left anterolateral chest wall, respiratory rate 36/min, SpO2 84% on 15 L face mask oxygen, and he is tiring. What is the definitive management of his respiratory failure?
- A Intubation and positive pressure ventilation ✓
- B Intercostal nerve blocks alone
- C Strapping of the flail segment with adhesive tape
- D Insertion of an intercostal chest drain
Correct answer: A. Intubation and positive pressure ventilation
Explanation
Flail chest causes respiratory failure through underlying pulmonary contusion and ineffective ventilation from paradoxical segment motion. When there is hypoxaemia refractory to mask oxygen with fatigue, intubation and mechanical positive pressure ventilation is indicated; it stabilises the chest wall internally and supports gas exchange while the contusion resolves. Strapping worsens atelectasis and restricts ventilation, nerve blocks help pain only, and a chest drain treats pneumothorax rather than ventilatory failure.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.