Right-sided multiple rib fractures and flail chest, right pulmonary contusion and subcutaneous emphysema.
Flail chest is defined as fracture of 2 or more adjacent ribs at 2 different points on each rib.
Flail chest can cause paradoxical bleeding, chest pain, pneumothorax with or without hemothorax, pulmonary contusion, cardiac contusion (causes arrhythmia and death) and aortic dissection.
The patient is emergently managed by placing chest tube on both sides of the lung at 5th intercostal space on anterior axillary line, then do positive pressure ventilation. Adjust the ventilator setting to avoid high pressure associated lung trauma.
Pain is controlled by epidural anesthesia. Nerve block is appropriate when only 1 rib is fractured but flail chest have multiple rib fractures.
Adapted from: Fundamentals of Cardiology: Concise Review for USMLE and General Medical Boards Image source: www.trauma.org You can also review all up-to-date materials in our book "Fundamentals of Cardiology".