You are working in your local emergency department and are notified of an incoming trauma patient. The victim was involved in a car crash at highway speeds, was not restrained, and was partially ejected from the driver’s side window.

Pre-arrival report from the medics indicate that he has a BP of 146/90, pulse of 130, and a respiratory rate of 36. He is very dyspneic and complains that he can’t breathe. They state that the only abnormality that they found on their exam was some bony crepitus over the left lateral chest.

When he arrives, he is exactly as billed. O2 saturations are 82%, and he is in obvious respiratory distress. Breath sounds are quite diminished on the left.

What are the potential diagnoses?

What do you do next? Here are your choices:

• Examine the airway
• Apply supplemental oxygen
• Intubate
• Obtain a chest x-ray
• Decompress the left chest with a needle
• Insert a chest tube
• Proceed to the operating room
• Obtain a CT scan of the torso

Please tweet or leave comments with your suggestions. I’ll review your choices on Monday, and provide some followup information. Final answer on Tuesday!