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Flail chest with pulmonary contusion — RCPSC EM MCQ

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ModerateTraumaFlail chest with pulmonary contusionRCPSC EM

A 39-year-old woman is ejected from a vehicle. Pelvis is stable and FAST is negative. She has flail motion of the left chest, pulmonary contusion on chest radiograph, oxygen saturation 89% and increasing work of breathing despite analgesia. What is the most likely diagnosis?

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Correct answer: E — Flail chest with pulmonary contusion causing respiratory failure

Paradoxical chest-wall motion with pulmonary contusion and hypoxaemia indicates flail chest physiology. Analgesia, ventilatory support and trauma admission are needed.

Reference: ATLS; Canadian trauma systems guidance