Pop Quiz: What I See…

Yesterday, I showed you an x-ray of a trauma patient and asked you to tell me all the pertinent things that you saw. Here’s the x-ray again:


And here’s the list of all the things that struck me about it. Tomorrow, I’ll explain how I figured them all out from just this x-ray.

  • The patient is a female
  • She is still on a backboard
  • She was stabbed with a long, professional cooking knife
  • The assailant was right handed
  • The course of the knife is left to right, superior to inferior, and anterior to posterior
  • She was unstable, either blood pressure or respirations
  • The patient was intubated, most likely due to hypotension and unresponsiveness (BTW, the tube is deep and needs to be pulled back)
  • There is a moderate left hemothorax
  • The mediastinum is shifted to the right
  • A deep sulcus sign is present, either from a pneumothorax that is not easily visible, or from a large hemothorax (more likely the first one)
  • Intra-abdominal and diaphragmatic injury is almost certain
  • A pulmonary contusion is present on the left
  • The stab enters the antero-lateral chest
  • It does not involve the arm or axilla
  • The patient needs a chest tube now
  • She must be taken to the OR immediately after the tube

Some of these are easy, some are not. Let me know if you found anything else by tweeting or commenting below.

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