رجل عمره ٧٢ سنة وقع في البيت وعنده كسر في ثلاثة أضلاع في اليسار بدون استرواح. يتنفس بسرعة وبشكل سطحي لأنه يتألم، ويرفض السعال، والتشبع ٩٣٪، والتنفس ٢٦، ويقيّم الألم ٩/١٠. ما الأولوية لمنع المضاعفات؟

A 72-year-old man fell at home and has three left rib fractures without pneumothorax. He breathes rapidly and shallowly because of pain and refuses to cough. SpO2 93%, RR 26, pain 9/10. What is the priority to prevent complications?

1. Strict bed rest without moving for a week
2. A tight compression binder around the chest all day
3. Effective analgesia enabling deep breathing and coughing
4. Fluid restriction to prevent pulmonary oedema

Answer: C) Effective analgesia enabling deep breathing and coughing. Pain prevents deep breathing, leading to atelectasis and pneumonia, especially in older adults. Good analgesia (including nerve blocks) with incentive spirometry is key. Binders restrict breathing and are no longer used.