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A 57 year old woman was a restrained front seat passenger, involved in a high speed, head on, motor vehicle accident. She was trapped for 30 minutes, during which time she was reported as being conscious but complaining of difficulty in breathing. On arrival in the emergency room, primary survey showed her airway to be intact. There was reduced air entry in the right chest, and dullness to percussion at both bases, with a respiratory rate of 40 breaths/min. Her initial blood pressure was 95/70 with a regular pulse of 120/min. Neurologically, she was conscious with a GCS of 15. Secondary survey showed extensive bruising in a seat belt pattern over her chest and abdomen. Abdominal skin over her lower abdomen was disrupted by a degloving injury. The soft tissues of her right breast were noted to be grossly distended.
Radiological examination showed an unstable fracture of the C2 vertebra, a large right haemothorax with multiple rib fractures …