A 45-year-old previously fit and healthy, female physiotherapist was walking her dog in fields. Cows in the field were frightened by her dog, resulting in her being trampled and crushed. She presented with severe pain in the chest along with pain in both shoulders. On examination she was severely short of breath. The only injury outside the chest was a minor scalp laceration. Radiographs of her chest revealed fractures of all 24 of her ribs and clavicles (fig 1) along with bilateral haemopneumothorax.

The patient was intubated …