Author: Andrew Lockyer / Editor: Jason Kendall / Reviewer: Louise Burrows, Srikanth Padmanabhan / Codes: CC1, T1 / Published: 10/10/2022
A 54-year-old driver of a pick-up truck was involved in a head on collision with a stationary vehicle at approximately 30mph. He was wearing a seatbelt, but his truck has no airbags. He denies any preceding symptoms and admits that he wasn’t paying attention as he approached a junction.
He suffered no loss of consciousness and after a short period left his vehicle independently. He describes mild pain in both wrists, as well as pain in a band across his anterior chest. He has no cough, and reports no dizziness or syncope since the accident.
He feels mildly breathless at rest and is having difficulty taking a deep breath. The patient is brought into the emergency department (ED) by ambulance but he is ambulant and suffering no other symptoms.
His only medical history is of osteoarthritis in his knees, and is on no regular medication. He smokes 20 cigarettes daily and has done for 30 years. He works as a labourer.
On examination, primary survey findings include: P 102, BP 123/76, SaO2 89% on air, RR 24 and GCS 15/15. He has anterior chest wall tenderness and reduced AE bilaterally because of poor chest excursion secondary to pain.
