UOTW #67

27 year old female brought in by ambulance after a high speed MVC. Vitals show a BP of 80 systolic and a heart rate of 140. There is evidence of significant chest trauma. Abdominal FAST is negative for free fluid. A subcostal view shows the following image:


7 thoughts on “UOTW #67

  1. Why was the patient tachycardic and hypotensive? No significant hemothorax on CT, but there are bilateral chest tubes present, and the abdominal FAST was negative, retroperitoneal bleed or some form of obstructive shock from the pneumomediastinum?

    1. Hi Robert,
      pneumomediastinum can compromise hemodynamic(tension) but the management would be surgical mediastinal decompression but not chest tube; In mild hemodynamic derangement 100% oxygen inhalation may be helpful; I don’t know there may be another reason for bilateral thoracostomy in this patient.

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