26 year old man. Low speed driver of motorbike vs. car.
Initial primary survey complete with soft tissue grazes on limbs only. Now increasingly agitated with falling BP.
Describe and interpret this CXR
CHEST X-RAY INTERPRETATION
There is a right tension pneumothorax with displacement of the mediastinum to the left.
There is a right sided air fluid level suggesting haemothorax.
No obvious rib or clavicular fractures.
This needs immediate recognition and a needle decompression.
Rapid progression to a decent size chest tube is indicated.
Hypotension could be due to circulatory shock from the tension pneumothorax (reduced venous return from raised intrathoracic pressure) or from the haemothorax.
Persistent hypotension after treating the tension would suggest hypovolaemia.