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Flail chest — DIPIMC MCQ

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ModeratePre-Hospital TraumaFlail chestDIPIMCDipIMC

A 60-year-old restrained driver in a high-speed collision has paradoxical movement of a segment of the right chest wall and increasing respiratory distress with falling saturations despite oxygen. What is the principal reason for his deterioration?

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Correct answer: B — Underlying pulmonary contusion impairing gas exchange

A flail segment indicates major force, and the chief cause of hypoxia is the underlying pulmonary contusion rather than the chest-wall movement itself. Pain-limited breathing contributes but does not explain progressive hypoxia, and diaphragmatic rupture, fat embolism and bronchospasm are not the typical mechanism. Management centres on oxygenation, analgesia and ventilatory support if needed. Pearl: anticipate that gas exchange in flail chest worsens over the first hours as the contusion evolves.

Reference: NICE NG39 (Major Trauma); JRCALC Clinical Guidelines