You are called about a 29-year-old Hispanic man who is experiencing an acute desaturation in his pulse oximetry. He was admitted last night as a multitrauma patient with potential chest, abdominal, and spinal injuries following a motor vehicle collision. He is currently intubated with a left chest tube and was stable until just before you were called. His oxygen saturation has been higher than 96% but now is 80%. Otherwise, vital signs are stable. A stat portable chest radiograph is obtained.
Answer
The radiograph shows an endotracheal tube, a left intravenous catheter, and a left chest tube. Of note is a right-sided consolidation consistent with a significant pulmonary contusion, as well as a right-sided pneumothorax. On the follow-up film, taken after a chest tube was placed, note how the consolidation has diminished with improved aeration.
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