The definitive treatment is to ensure adequate
oxygenation, administer fluids judiciously, and provide
analgesia to improve ventilation. The latter can be
achieved with intravenous narcotics or local anesthetic
administration, which avoids the potential respira-tory depression common with systemic narcotics. The
options for administration of local anesthetics include
intermittent intercostal nerve block(s) and intrapleu-ral, extrapleural, or epidural anesthesia. When used
properly, local anesthetic agents can provide excellent
analgesia and prevent the need for intubation. How-ever, prevention of hypoxia is of paramount importance
for trauma patients, and a short period of intubation
and ventilation may be necessary until diagnosis of the
entire injury pattern is complete. A careful assessment
of the respiratory rate, arterial oxygen tension, and
work of breathing will indicate appropriate timing for
intubation and ventilation.