What condition is most likely indicated by a patient demonstrating intercostal use and sternal retractions?

• A. Carbon monoxide poisoning
• B. Upper airway obstruction
• C. ARDS
• D. Flail chest

Answer: (B)

The presence of intercostal use and sternal retractions in a patient typically indicates increased respiratory effort due to some form of respiratory distress. This situation often arises when there is an obstruction in the upper airway, which leads to increased work of breathing as the body struggles to move air through the compromised airway.

In this context, intercostal muscle usage signifies that the patient is actively engaging accessory muscles to assist with breathing, often as a response to inadequate air flow. Sternal retractions further highlight significant work being exerted to maintain ventilation—this is often a sign that the air passage is obstructed, which can occur in cases of upper airway obstruction.

While carbon monoxide poisoning, ARDS, and flail chest may produce respiratory symptoms, they typically don't present with the specific physical signs of intercostal use and sternal retractions that indicate an upper airway issue. Instead, carbon monoxide poisoning primarily causes hypoxia without visible respiratory distress symptoms like retractions. ARDS involves diffuse lung inflammation leading to pulmonary edema, which would present differently and often include bilateral crackles rather than retractions. Flail chest relates to structural damage of the chest wall and may lead to paradoxical movement, but it is also distinguishable through its distinct physical signs.

In