TY - JOUR T1 - Rib fracture fixation in a patient on veno-venous extracorporeal membrane oxygenation following a motor vehicle collision JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-001004 VL - 7 IS - 1 SP - e001004 AU - Yousof Fawzy AU - David Hindin AU - Bradley Faliks AU - Jamie Tung AU - Joseph D Forrester Y1 - 2022/11/01 UR - http://tsaco.bmj.com/content/7/1/e001004.abstract N2 - An individual in their 20s presented to our trauma center via flight transfer from an outside hospital after sustaining multisystem trauma as a helmeted motorcyclist. The patient arrived intubated with two right-sided chest tubes and one left-sided chest tube. Clinical exam identified flail chest and flail sternum, right pneumothorax with right pneumomediastinum, and extensive subcutaneous emphysema (see figure 1). The patient’s persistent hypoxia prompted bedside bronchoscopy, which revealed a 25% circumferential tear in the right middle lobe bronchus proximal to takeoff.Figure 1 Bilateral rib fractures with flail segment, as seen in (A) three-dimensional reconstruction of initial CT and (B) flattened image of the chest wall.Additional injuries identified after CT included left grade 1 kidney injury, right superior pubic ramus fracture, left sacral fracture, left L5 inferior facet fracture, left sacral ala fracture with extension to left S1 and S2 foramina, right L1 to L4 transverse process fractures, right scapular body fracture, severe contusions of the right lung (severe blunt pulmonary contusion with >20% … ER -