رجل عمره ٦٦ سنة بعد سقطة أُدخل للعناية، صار عنده ألم في الصدر عند التنفس وكدمة على الجهة اليمنى، و٣ أضلاع مكسورة. التنفس ٢٦ سطحي، والتشبع ٩١٪، ويرفض الكحة من الألم. ما أهم إجراء؟

A 66-year-old admitted after a fall has pleuritic chest pain, bruising on the right side and 3 broken ribs. RR 26 and shallow, SpO2 91%, and he refuses to cough because of pain. What is most important?

1. Preventing coughing altogether
2. Good analgesia, deep breathing
3. Immobile rest for a week
4. A tight compressive chest binder

Answer: B) Good analgesia, deep breathing. Rib fractures in older adults cause shallow breathing leading to pneumonia; good analgesia, deep breathing and incentive spirometry are key. Tight binding is contraindicated.