Just a quick request of the lists views.
Case: 55 year old fit and well male falls 4 feet of a ladder onto the right
side of the chest. Presents to A+E with right sided chest pain, decreased
chest expansion and decreased air entry on that side. However, he is
generally well seen by SHO in A+E and gets an erect AP X-ray.
The film is of good quality and shows a fracture of the 4th rib. There is a
small (5cm) area of surgical emphysema seen on the chest film laterally
which is just palpable clinically. There is also blunting of the
costophrenic angle - presumably blood. There is no radiographic evidence of
pneumothorax (though there must be one).
He is going to be admitted for observation anyway. The question is should
you put a formal chest drain in this man?? We did not. The decision we made
has been criticised by some of our collegues.
Simon Carley
Anaesthetics / Intensive Care
Stepping Hill Hospital
Stockport
England
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