Question

A 54-year-old lady crashes her car against a telephone pole at high speed. On arrival at the E.R. she is in moderate respiratory distress. She has multiple bruises over the chest, and multiple site of point tenderness over the ribs. X-Rays show multiple rib fractures on both sides. On closer observation it is noted that a segment of the chest wall on the left side caves in when she inhales, and bulges out when she exhales. Dx? Next step if she is going to OR? Next step if not doing well?

Answer 1

The patient's symptoms and physical findings are suggestive of flail chest, a condition caused by multiple rib fractures. The next step if the patient is going to the OR is to stabilize the chest wall. If the patient is not doing well, the next step is to perform a tension pneumothorax decompression.

Step-by-step explanation:

The patient's symptoms, physical findings, and imaging studies are suggestive of a condition called flail chest. Flail chest occurs when multiple ribs are fractured in multiple places, causing a segment of the chest wall to become detached from the rest of the chest. This segment moves paradoxically with respiration, bulging out during exhalation and caving in during inhalation. In this case, the left side of the chest wall is affected.

If the patient with flail chest is going to the operating room, the next step would be to stabilize the chest wall. This may involve surgical fixation of the fractured ribs or the use of external devices such as strapping or a vacuum-assisted closure system.

If the patient is not doing well and requires immediate intervention, the next step would be to perform a tension pneumothorax decompression. This involves inserting a needle or a chest tube into the chest to relieve the pressure buildup and allow the lung to expand.