User login
ANSWER
The radiograph shows 3 abnormalities:
(1) The endotracheal tube is in the right mainstem bronchus—a finding that in part leads to
(2) A whiteout of the left lung; the latter is due partly to collapse and atelectasis and partly to a possible pneumothorax.
(3) There is evidence of free air under the left hemidiaphragm, which is concerning for an intra-abdominal injury, such as a perforated viscus.
The patient’s endotracheal tube was partially withdrawn, and a left chest tube was placed. Subsequent CT of the abdomen confirmed the finding of free air. She was then taken to the operating room for an emergent laparotomy.
ANSWER
The radiograph shows 3 abnormalities:
(1) The endotracheal tube is in the right mainstem bronchus—a finding that in part leads to
(2) A whiteout of the left lung; the latter is due partly to collapse and atelectasis and partly to a possible pneumothorax.
(3) There is evidence of free air under the left hemidiaphragm, which is concerning for an intra-abdominal injury, such as a perforated viscus.
The patient’s endotracheal tube was partially withdrawn, and a left chest tube was placed. Subsequent CT of the abdomen confirmed the finding of free air. She was then taken to the operating room for an emergent laparotomy.
ANSWER
The radiograph shows 3 abnormalities:
(1) The endotracheal tube is in the right mainstem bronchus—a finding that in part leads to
(2) A whiteout of the left lung; the latter is due partly to collapse and atelectasis and partly to a possible pneumothorax.
(3) There is evidence of free air under the left hemidiaphragm, which is concerning for an intra-abdominal injury, such as a perforated viscus.
The patient’s endotracheal tube was partially withdrawn, and a left chest tube was placed. Subsequent CT of the abdomen confirmed the finding of free air. She was then taken to the operating room for an emergent laparotomy.
An air ambulance emergently transports a young woman from the scene of a motor vehicle collision to your facility. The details of the accident and age of the patient are unknown. The air ambulance crew had intubated her en route for a decreased level of responsiveness and for airway protection.
The patient is brought to your trauma bay, where you note an intubated female teenager who is unresponsive, with a Glasgow Coma Sc
Her pupils are equal and react bilaterally, albeit sluggishly. Her right leg was placed in an immobilizer by the air ambulance crew because they had noted a right thigh deformity.
Before completing your primary survey, you obtain a portable chest radiograph (shown). What is your impression?
