#march2020mccqe1
A 23-year-old man is transferred to the Emergency Department following a demolition site accident in which a beam fell on him and pinned him by the chest. He has a clear airway and is able to speak to you in gasps. His BP is 110/75mmHg and pulse rate is 105/min. Air entry is diminished over the right side of the chest, with a small area of subcutaneous emphysema palpable posteriorly. Computed tomography (CT) shows he has bilateral rib fractures from the right second through to the seventh ribs with a small haemopneumothorax on the right as illustrated. After the scan his breathing becomes more laboured and he shows signs of paradoxical respiration of chest wall retraction during inspiration. Which one of the following is the most appropriate initial action to take in his management?
(A) Strap the chest
(B) Insert a right-sided pleural underwater-sealed drain
(C) Aspirate the right pneumothorax
(D) Institute positive-pressure ventilation via an endotracheal tube
(E) Administer bilateral intercostal blocks for analgesia
A 23-year-old man is transferred to the Emergency Department following a demolition site accident in which a beam fell on him and pinned him by the chest. He has a clear airway and is able to speak to you in gasps. His BP is 110/75mmHg and pulse rate is 105/min. Air entry is diminished over the right side of the chest, with a small area of subcutaneous emphysema palpable posteriorly. Computed tomography (CT) shows he has bilateral rib fractures from the right second through to the seventh ribs with a small haemopneumothorax on the right as illustrated. After the scan his breathing becomes more laboured and he shows signs of paradoxical respiration of chest wall retraction during inspiration. Which one of the following is the most appropriate initial action to take in his management?
(A) Strap the chest
(B) Insert a right-sided pleural underwater-sealed drain
(C) Aspirate the right pneumothorax
(D) Institute positive-pressure ventilation via an endotracheal tube
(E) Administer bilateral intercostal blocks for analgesia
