The diagnosis is clinical and depends upon recognising paradoxical chest wall movement in the presence of multiple fractures on the chest X-ray. Ventilation is impaired, coughing is ineffective and the injuries are usually very painful. This injury should not be underestimated, assisted ventilation may be necessary. The patient should be monitored and observed in an HDU or ITU. Thoracic epidural analgesia is often used to provide pain relief to facilitate respiration and clearing of secretions.

Encourage collaboration to prevent the group from splitting up the work, then putting it together to turn in; you want them to “construct their learning together”. Also, explain to the students why it is important that they work collaboratively and that it is a requirement.

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Others err by indulging their pets too much, as in the matter of giving treats. Overweight animals tend to live shorter lives and have greater medical problems as they age. Attending to the dog’s true needs, such as adequate food and exercise may create a happier and healthier dog than one that always gets a treat when it begs.

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