A 32-year-old male arrives in the emergency department 15 minutes after a high-speed motor vehicle crash. He complains of sudden, sharp left-sided chest pain and increasing shortness of breath. On examination he is tachypneic, has diminished breath sounds on the left, and his oxygen saturation is 91 % on room air. Which injury is the most likely cause of this patient's symptoms?
Blunt chest trauma can allow air to leak from the lung into the pleural space, producing a traumatic pneumothorax. Classic findings include sudden ipsilateral pleuritic chest pain, dyspnea, and decreased or absent breath sounds on the affected side. Pulmonary contusion and tamponade may also occur after blunt trauma but usually present with diffuse chest findings or hemodynamic compromise rather than abrupt unilateral pleuritic pain with absent breath sounds. Pulmonary embolism is less likely in the immediate post-impact period and typically lacks unilateral absent breath sounds.
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Respiratory Emergencies
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