• The clinical diagnosis based on history of rib fractures, re | Surgery videos & books

• The clinical diagnosis based on history of rib fractures, respiratory distress and hypotension is pneumothorax. There can be concomitant hemothorax but treatment of obstructive shock caused by pneumothorax is the immediate step • This would be done by inserting a wide bore needle in second intercostal space to reduce the impact of obstructive shock and increase systolic blood pressure.