رجل عمره ٤٨ سنة بعد حادث سيارة اصطدم صدره بالمقود. جزء من جدار صدره الأيمن يدخل للداخل مع الشهيق ويخرج مع الزفير، مع ضيق نفس وألم شديد. التنفس ٣٢، والتشبع ٨٨٪، والنبض ١٢٠. ما التشخيص؟

A 48-year-old man struck his chest on the steering wheel in a car crash. Part of his right chest wall moves inward on inspiration and outward on expiration, with breathlessness and severe pain. RR 32, SpO2 88%, HR 120. What is the diagnosis?

1. A pleural effusion straight after injury
2. An open pneumothorax needing a dressing
3. A single simple stable rib fracture
4. Flail chest

Answer: D) Flail chest. Multiple adjacent ribs fractured in several places let a segment move paradoxically. The main danger is the underlying pulmonary contusion. Treatment is strong analgesia, oxygen and sometimes positive-pressure ventilation.