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Flail chest with respiratory failure — ABEM Board MCQ

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HardTraumaFlail chest with respiratory failureABEM Board

A 55-year-old man is brought as triage level 1 after blunt chest trauma. He has paradoxical motion of the left chest wall, RR 36/min, oxygen saturation 86% on nonrebreather, PaCO2 58 mm Hg, and multiple displaced rib fractures on x-ray. Which of the following is the most appropriate next step in management?

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Correct answer: A — Endotracheal intubation with lung-protective ventilation and aggressive analgesia

Flail chest with respiratory failure requires ventilatory support and pain control; rib binding can worsen ventilation.

Reference: ATLS principles; EAST rib fracture guidance