A 19-year-old male unrestrained driver was involved in a single-car motor vehicle crash. He drove off the road and down an embankment and struck a tree. The car rolled over 180 degrees onto its roof with 18- to 24-inch intrusion. The patient had a blood alcohol level of 294 mg/dL and his urine drug screen was positive for cocaine and cannabinoids. The patient was found 4 hours after the crash occurred and transported to the trauma centre. A primary survey revealed that the patient was alert, orientated, and responded to verbal stimuli. His airway was intact and he was moving air in both lung fields, but his breath sounds were diminished. He was slightly tachycardic, normotensive, and tachypneic. Radiographic films demonstrated the following injuries: a left parietal epidural hematoma, left parietal skull fracture, right sacral ala fracture, right fibula fracture, right humerus fracture, and left tibial fracture. This case study emphasised the importance of radiographic imaging in the diagnosis and management of chest injuries. The diagnostic goal of chest radiography in chest trauma is to identify significant injury. Keep in mind that the initial plain chest radiograph usually is performed with the patient in the supine position and with poor technique under emergency conditions. Exclusive reliance on plain chest radiographs may be misleading. They should serve as a screening tool rather than a definite diagnostic test. Fractures, pneumothoraces, and mediastinal abnormalities may be missed on the initial radiograph. If a patient is symptomatic or the mechanism of injury suggests injury, repeat radiographs, chest CT scans, or an aortogram is recommended. Finally, maintaining a high level of suspicion for injury along with serial physical examination is an unbeatable combination in caring for the acutely injured patient. (Author/publisher)
Abstract