A 31-year-old woman is admitted to the emergency department following a motor vehicle acci-dent. The paramedics brought her into the ER in respiratory distress
She was intubated in the field and started on mechanical ventilation as soon as she arrived. Breath sounds were clear on the left and absent on the right. Percussion revealed resonance on the left and hyperresonance on the right. The patient's trachea was shifted to the left. The most likely cause of this patient's clinical presentation is which of the following?
a. Acute respiratory distress syndrome (ARDS)
b. Flail chest
c. Pneumothorax
d. Pleural effusion
ANS: C
Absent breath sounds on the right side with hyperresonance means there is excessive air in the pleural cavity on the right side. A tracheal shift to the left indicates that there is either a right-sided pneumothorax or left-sided atelectasis. The presence of the hyperresonance with the tracheal shift and absent breath sounds points to the pneumothorax.
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