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Flail chest with respiratory failure — RCPSC EM MCQ

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HardTraumaFlail chest with respiratory failureRCPSC EM

A 63-year-old falls from a roof and has paradoxical movement of the left chest wall. RR is 36/min, oxygen saturation is 88% on high-flow oxygen, and ABG shows pH 7.28 with PaCO2 58 mmHg. CT shows multiple segmental rib fractures and pulmonary contusion. What is the most likely diagnosis?

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Correct answer: A — Flail chest with pulmonary contusion and ventilatory failure

Flail chest with pulmonary contusion and ventilatory failure is correct: the clues indicate Flail chest with respiratory failure and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: ATLS; Canadian trauma critical care practice