Student Home Contact My Instructor EXAM 7 01:55:02 Remaining 100 Questions Question #60 Discuss in Class You have a 30-year-old patient who was the driver of a vehicle that was hit in the driver’s side door. The patient is unresponsive, trachea is midline, neck veins are flat, lung sounds are absent on the left side, and percussion reveals hyporesonance. The patient has a rapid carotid pulse and absent radial pulses and is not demonstrating any paradoxical breathing, though appears to have some broken ribs on the left side. The abdomen is flat and non-tender. Which of the following is this patient MOST likely suffering from? Rupture of the aorta. Massive hemothorax. Simple pneumothorax. Tension pneumothorax. © 2024 Platinum Educational Group, LLC. Student Home Contact My Instructor EXAM 7 01:55:02 Remaining 100 Questions Question #60 Confidence Level Discuss in Class Leave Feedback You have a 30-year-old patient who was the driver of a vehicle that was hit in the driver’s side door. The patient is unresponsive, trachea is midline, neck veins are flat, lung sounds are absent on the left side, and percussion reveals hyporesonance. The patient has a rapid carotid pulse and absent radial pulses and is not demonstrating any paradoxical breathing, though appears to have some broken ribs on the left side. The abdomen is flat and non-tender. Which of the following is this patient MOST likely suffering from? Rupture of the aorta. Massive hemothorax. Simple pneumothorax. Tension pneumothorax. © 2024 Platinum Educational Group, LLC.
The Correct Answer and Explanation is:
Correct Answer: Massive hemothorax
Explanation
The patient in this case is likely suffering from a massive hemothorax, a condition characterized by the rapid accumulation of more than 1,500 mL of blood in one side of the pleural cavity. This condition typically results from major blunt or penetrating trauma to the chest that damages the lung parenchyma, intercostal vessels, or great vessels within the thoracic cavity.
Key clinical findings pointing to a massive hemothorax include absent breath sounds on one side and dull (hyporesonant) percussion over the affected hemithorax, as blood (a fluid) dulls the sound on percussion. This is distinct from a pneumothorax, which would present with hyperresonance due to the presence of air. The flat neck veins suggest hypovolemia due to blood loss rather than increased intrathoracic pressure, as seen in tension pneumothorax (which would cause distended neck veins). The midline trachea also helps rule out a tension pneumothorax, which typically causes tracheal deviation away from the affected side.
The absence of paradoxical movement (which would suggest a flail chest) and a flat, non-tender abdomen further narrow the problem to the thoracic cavity. The presence of a rapid carotid pulse with absent radial pulses indicates early signs of shock, consistent with significant blood loss, but without enough hypotension to lose central pulses yet.
In contrast:
- A simple pneumothorax would not cause this degree of hemodynamic compromise or hyporesonance.
- A tension pneumothorax would cause hyperresonance, tracheal deviation, and distended neck veins.
- Aortic rupture often causes immediate death or presents with profound shock and unequal blood pressures in limbs, which is not clearly described here.
In summary, the constellation of blunt trauma, absent breath sounds, dull percussion, flat neck veins, and signs of shock strongly supports a diagnosis of massive hemothorax.