Several of you figured this one out! The patient was involved in a high speed car crash and was brought to the ED in respiratory distress. Decreased left sided breath sounds were noted. The following xray was obtained.
Opacity is noted in the left lung field, and a modest pneumothorax is seen on the right. Bilateral first ribs are fractured, and the left second through fourth ribs are also broken. The patient was intubated and bilateral chest tubes were inserted.
There was minimal blood from the left chest tube, and a small amount of air from the right. Note the extensive subcutaneous emphysema.
What should we do next? Are any other diagnostic tests indicated? Could the endotracheal tube placement be part of the problem?