A 27-Year-Old Man Is Brought to the Emergency Department After

question 398

Multiple Choice

A 27-year-old man is brought to the emergency department after a high-speed motor vehicle collision.  On arrival, his blood pressure is 90/52 mm Hg, pulse is 122/min, and respirations are 30/min.  The patient is in moderate respiratory distress.  There are bruises on the anterior chest wall and abdomen.  No breath sounds are heard in the left lung, and initial chest x-ray shows hemopneumothorax.  Fluid resuscitation is given, left-sided chest tubes and a nasogastric tube are placed, and the patient is admitted to the trauma floor after stabilization.  Four days later, the chest tubes continue to drain appropriate serosanguinous fluid, but the patient still feels short of breath.  He has an occasional dry, nonproductive cough.  Current temperature is 36.8 C (98.2 F) , blood pressure is 118/78 mm Hg, pulse is 88/min, and respirations are 20/min.  A repeat chest x-ray shows the following. Which of the following is the most likely cause of the patient's continued respiratory distress?

• A)Aortic rupture
• B)Diaphragmatic injury
• C)Flail chest
• D)Left lower lobe pneumonia
• E)Pulmonary embolism
• F)Recurrent pneumothorax

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