A 24-year-old woman is brought to your facility emergently after being the victim of a drive-by shooting. She sustained a single gunshot wound to the left axilla. She is 12 weeks pregnant.
On arrival, her vital signs include a blood pressure of 135/50 mm Hg and a heart rate of 100 beats/min, with an oxygen saturation of 90% on supplemental oxygen. She is unable to move or feel anything from the waist down.
Within the hour, her breathing becomes more labored and she is intubated, during which time her blood pressure drops to 90/47 mm Hg and oxygen saturation to 75%. An urgent chest radiograph is obtained.
ANSWER
The radiograph shows a bullet lodged near the vertebral body of T10. A fracture of the left sixth rib is present, as well as a large left hemothorax with no evidence of pneumothorax. A chest tube was urgently placed, with good results (as noted on the follow-up film shown).
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