scenario007
This patient has a flail chest with underlying pulmonary contusion, as evidenced by the chest X-ray. Flail chest per se does not require intervention, and the old concept of 'pendeluft' or paradoxical chest wall movement leading to inadequate intrathoracic gas exchange has now been discarded.

However patients with flail chest often have significant underlying pulmonary contusion and it is this that warrants tracheal intubation and ventilation. Thus the persistently low saturations and high respiratory rate are indications for intubation in this case.


While chest tube thoracostomy may subsequently become necessary, especially in the presence of multiple rib fractures and positive pressure ventilation, there is little evidence of a tension pneumothorax and this procedure is not emergent for this patient. Splintage of the chest wall with external bandaging has no place in the tratment of rib fractures.