A 64 year old female has difficulty breathing after being kicked by a horse. You observe paradoxical left chest wall movement. Her initial vital signs are P 108, R 18, BP 110/84, and SpO2 is 95% on oxygen by nasal cannula. As you prepare to transport her, you observe her respiratory rate is increasing while her SpO2 is decreasing. Which of the following should be the goals of your treatment? Select the single best option.

• A. Assisting her ventilation
• B. Placing her in recumbent position
• C. Increasing oxygen
• D. Administering nitro for pain

Answer: (A)

When a patient has paradoxical chest wall movement after blunt chest trauma, a flail chest is present. That detached segment moves in the opposite direction of the rest of the chest, making ventilation inefficient and increasing the work of breathing. Seeing the respiratory rate rise while SpO2 falls shows the patient is tiring and needs more support than oxygen alone can provide.

The best goal is to assist ventilation. Using a bag‑valve mask with high-flow oxygen delivers positive pressure to help expand the lungs, stabilize the flail segment, and improve tidal volume and overall oxygen delivery. Oxygen by itself won’t fix the mechanical instability, and the patient will typically need continued ventilation support and rapid transport to a trauma facility.

Placing the patient in a recumbent position is not advantageous here for breathing mechanics. Nitro for pain isn’t appropriate in trauma unless there’s a specific cardiac cause, and it won’t address the ventilation problem in a chest-injury scenario. Focus on stabilizing ventilation first, with ongoing monitoring and rapid transport.