case 2

The Unrestrained Driver

BACKGROUND

A 26-year-old man is involved in a high-speed motor vehicle collision. The patient’s oropharynx is clear, his airway is patent, and his trachea appears to be shifted to the right of midline. The patient’s breath sounds are decreased and percussion of the left chest demonstrates hyperresonance. Standard trauma x-rays, including an anteroposterior (AP) chest and pelvis scan, and an emergent procedure are performed.

What is the underlying pathology, and what procedure was performed?

Hint: The cause of this patient's hypotension and hypoxia is a clinical diagnosis, and although a portable chest radiograph was performed in this case, this condition should not typically require imaging

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