0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

Image of the Month—Interactive Quiz

Image of Figure 1

Figure 1.
Supine anteroposterior chest radiograph revealing subcutaneous emphysema, rib fractures, pulmonary contusions, and a rightward mediastinal shift.

Derek J. Roberts, BSc(Pharm), MD; Chad G. Ball, MD, MSc, FRCSC; Corina Tiruta, BSc; Andrew W. Kirkpatrick, MD, FRCSC

A 46-year-old restrained male driver involved in a high-speed head-on collision presented with hemodynamic instability (systolic blood pressure = 90 mm Hg, heart rate = 139 beats/min) following prehospital intubation for hypoxia. Extensive bruising to the patient's left hemithorax with a large flail segment and subcutaneous emphysema were noted. His trachea was midline with reported bilateral equal breath sounds on auscultation. Bilateral tube thoracostomy was performed. Despite aggressive fluid resuscitation, the patient remained transiently hemodynamically unstable. Although the initial supine anteroposterior chest radiograph displayed a mild rightward mediastinal shift, there was no evidence of an overt residual pneumothorax (Figure). The focused assessment with sonography for trauma examination also identified a small amount of perisplenic fluid concurrent to a normal pericardial space.

See the full article for an explanation and discussion.