Civil defense ambulance is dispatched to a 2-

car head on collision. Upon arrival to the scene

an unrestrained adult driver is found inside the
vehicle with steering wheel deformity. When
arrived to the ER, patient was Complaining of
severe chest pain & difficulty breathing . The
patient is A & O x3 but appears restless and
agitated
What is your approach?
What is x3 ?

Primary survey

Airway: Patent

Breathing: RR: fast; labored with asymmetric chest expansion and use of accessory muscles but no
paradoxical movement;

left side appears hyperinflated and does not move. Breath sounds absent on left, diminished on right; no
adventitious sounds. No open wounds; trachea midline. SpO2 86%, EtCO2 27.

Circulation: JVD present (JVP is raised); radial pulses absent; carotid pulses fast.

Disability/LOC: Eyes open spontaneously, pt is awake, alert & oriented to voice & is able to move all
extremities to command;

Vital signs :

BP 74/50

P 116

R 24

1. What two immediate life-threats should be suspected based on this presentation?

2. Which one is most likely based on the mechanism of injury? What is the pathophysiology?
3. What temporizing life-saving procedure must be performed immediately?
4. Management of hypotension ?
5. Why was the trachea midline?