A 38-year-old woman is brought emergently to your facility following a single-vehicle collision. She was the driver and apparently lost control of the car; EMS personnel reported a long extrication time.
Upon arrival, the patient has a blood pressure of 95/40 mm Hg and a heart rate of 95 beats/min. Her Glasgow Coma Scale score is 12 to 13. Primary survey shows obvious extensive facial fractures, as well as a right distal femur fracture. She is not actively following commands and is becoming increasingly combative; hence, she is electively intubated to protect her airway.
Preliminary radiographs are obtained, and a portable pelvis view is shown.
ANSWER
The radiograph demonstrates no obvious evidence of fracture within the hip. Of note, however, is lucency on both lateral aspects of the abdomen, which is greater on the right than the left side. This finding is suggestive of free intraperitoneal air and warrants further work-up and imaging to rule out intra-abdominal injury.
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