Blunt diaphragmatic rupture

Traumatic

Step 1: View clinicals

An 18-year-old girl is brought in by first responders about 20 minutes after she was involved in a motor vehicle accident. She was an unrestrained rear seat passenger, with no history of ejection from the vehicle. En route to the hospital, she was intubated and ventilated due to her GCS score being 7/15 (E2-V1-M4). Her medical and surgical histories are unknown. At the scene of the accident, the driver, who only had minor injuries, related that he had picked her up from a restaurant, and was driving her home.


Step 2: Order all relevant investigations

Chest X-ray

There is a large left-sided pneumothorax, along with a markedly elevated left hemidiaphragm. The right hemidiaphragm appears normal. There are no apparent rib fractures.

CT thorax and abdomen

There is a large left-sided pneumothorax and a small right-sided hemothorax. Bilateral lung contusions are present. A left diaphragmatic rupture is noted. The intra-abdominal viscera appear normal.

FAST scan

No evidence of free fluid.

CT brain

The CT brain appears to be normal.


Step 3: Select appropriate management

Nasogastric (NG) tube
Bilateral chest tubes
Emergency laparotomy
Blood transfusion


Score: ★★☆