Case vignette

A 31-year-old African–American male with no significant past medical history presents to the emergency department via emergency medical services with chest pain and shortness of breath following a direct, broadside motor vehicle collision at high speed. Initial vital signs included a pulse of 130 beats/min, blood pressure 125/95 mm Hg, respiratory rate of 35 times/minute with a pulse oximetry of 92% on room air. On physical exam, he has decreased breath sounds on the left, pain to palpation of left ribcage, minor abrasions of left wrist and elbow. His Glasgow Coma Scale is 15.

Key questions

1. Before looking at the chest x-ray, what are your differential diagnoses for chest pain and shortness of breath in blunt thoraco-abdominal trauma?

2. What other findings are in figure 1?

3. Does figure 1 narrow down your differential diagnosis or change it in any way?

4. What key thing needs to occur in the emergency department? See figure 2.

5. What was …