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Flail chest with pulmonary contusion — ABEM Board MCQ

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ModerateTraumaFlail chest with pulmonary contusionABEM Board

A 58-year-old man arrives after a steering-wheel impact. Triage acuity is ESI 2; BP 118/76 mm Hg, HR 110/min, RR 30/min, SpO2 89%. He has paradoxical movement of the left chest wall and diffuse crackles on that side. Chest radiograph shows multiple segmental rib fractures. Which of the following is the most likely diagnosis?

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Correct answer: D — Flail chest with pulmonary contusion

Paradoxical chest wall motion from multiple segmental rib fractures with hypoxia supports flail chest and associated pulmonary contusion.

Reference: ATLS chest trauma guidance