06-25-2007, 05:05 AM
A 22-year-old woman is brought to the emergency department following a motor vehicle accident. She
was an unrestrained driver in a head-on collision. She was unresponsive on the scene and was
intubated by the EMTs on the field. She has no known medical history or drug allergies. She is able to
breath spontaneously and has a cervical collar in place. Her blood pressure is 120/60 mm Hg, pulse is
90/min, and respiratory rate is 32/min. Her oxygen saturation on 100% oxygen is 100%. She has
multiple ecchymoses over her left chest and her trachea is midline. Breath sounds are diminished over
the left side. The remainder of the examination is unremarkable. Based on the available information, the
most appropriate next diagnostic step is to
A. obtain a CT scan of the abdomen
B. order a chest radiograph at maximal inspiration
C. order a chest radiograph at maximal expiration
D. order an echocardiogram
E. order a ventilation-perfusion scan
was an unrestrained driver in a head-on collision. She was unresponsive on the scene and was
intubated by the EMTs on the field. She has no known medical history or drug allergies. She is able to
breath spontaneously and has a cervical collar in place. Her blood pressure is 120/60 mm Hg, pulse is
90/min, and respiratory rate is 32/min. Her oxygen saturation on 100% oxygen is 100%. She has
multiple ecchymoses over her left chest and her trachea is midline. Breath sounds are diminished over
the left side. The remainder of the examination is unremarkable. Based on the available information, the
most appropriate next diagnostic step is to
A. obtain a CT scan of the abdomen
B. order a chest radiograph at maximal inspiration
C. order a chest radiograph at maximal expiration
D. order an echocardiogram
E. order a ventilation-perfusion scan