Images Tina Cullen, text Genevieve Carbonatto
It is 10.00 pm and you get a BAT call. There has been a fight at the local pub and the ambulance are bringing in a 34 year old who has been stabbed in the chest. He is tachycardic and hypotensive, GCS 14. They will arrive in 10 minutes. The trauma team gets activated, the cardiothoracic surgeons and cardiac anaesthetists are called down. Intubation equipment is set up as is the chest tube trolley, the cannulation trolley and of course the ultrasound machine is set up. The machine gets plugged in and turned on and placed strategically to the right of the bed the patient will be brought into without interfering with access to the patient. The probes are covered for infection control as you expect blood to be around. All probes are covered.
The patient gets wheeled in. He is conscious, tachycardic 113/min and hypotensive – 86/40. He has a stab wound to the anterior chest at the level of the 4th intercostal space in the midclavicular line. At the scene he has had a needle decompression for presumed left pneumothorax and the needle is still in situ in the 2nd intercostal space of his left chest anteriorly.
Left anterior chest:
Lung sliding no pneumothorax .
Right anterior chest:
Lung sliding, no pneumothorax.
He has a left sided haemothorax.
Semi PLAX view downward tilt to see the pericardium).
He has a haemopericardium.
The patient is transferred immediately to theatre.