Case 161: Car Accident
This man was involved in a high speed car accident. He was wearing a seatbelt. The chest injuries seen are the only injuries sustained.
1. What does the Chest Xray show?
The chest Xray displays many features of severe chest trauma. There are fractures of the left clavicle, and the upper five left sided ribs, including the first rib. There is already patchy consolidation of the left lung field consistent with lung contusion.2. How would you manage the problem in the emergency department?
As per any multiply injured patient, guided by ATLS (or EMST) principles.Important aspects concerning the chest injury include:
* high flow oxygen
* analgesia
* continuous oxygen saturation measurements
* assessment for a flail segment and subsequent respiratory mechanical failure
* possible early intubatiion and mechanical ventilation
* consideration of early chest tube insertion
* CXR
* cardiac investigations - ECG, troponin, Echocardiogram, for possible associated cardiac contusion
* CT chest with CT angiogarphy of the great vessels for possible major vessel injury
* Intensive care referral
3. What are the possible complications this man may have during his hospital stay?
* Respiratory failure* pneumothorax
* DVT
* Pulmonary embolus
* chest infection / pneumonia
* empyema