Flail chest causes paradoxical chest wall movement leading to ineffective ventilation and hypoxia. Positive-pressure ventilation stabilizes the chest wall internally, improves oxygenation, and decreases the work of breathing. Immediate referral to a trauma center ensures specialized management of associated injuries. Chest physiotherapy or oral analgesics alone are insufficient for respiratory compromise in flail chest. Chest tube insertion is indicated only if there is a pneumothorax or hemothorax, not as primary treatment for flail chest. Early ventilatory support is critical to prevent respiratory failure and reduce mortality.

Reference: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Judith E. Tintinalli, 9th Edition.