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 in the context of trauma is hypovoloaemia from haemorrhage (somewhere) until proven otherwise. A diagnosed haemopneumothorax can contribute to hypotension in 2 ways;
- Hypovolaemic shock from the blood extravasating into the chest
- Obstructive shock from the raised intrathoracic pressure obstructing venous return