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It would be interesting to know what the trauma center did to work him up on initial presentation...
As stated prior, SW in this area need further workup. Typically if they are hemodynamically stable the workup involves an upright CXR to evaluate a pneumo or hemothorax and an echo is obtained to look at the pericardial sac for fluid as a tamponade could be occuring without any symptoms or signs until it is too late. A repeat xray should be obtained after 3-6 hours depending on who you read to look for a slowly occuring leak and subsequent pneumo. In my experience, most patients with pnemothoraces do not cough until the pneumo is evacuated but everyone's cases are different.
If the patient had been unstable a trip to the OR would have been in order for either a sternotomy or a pericardial window to look and see if fluid exists around the heart.
Regardless, the patient should have returned to the trauma center to be re-evaluated after bleeding as its better to assume the worst and find nothing than to assume the best and have a dead patient...
I disagree with your nurse that the patient should have stayed at your facility after the above mentioned events. Sometimes bad things happen slowly and if he didn't stay long at the trauma center subtle clues could be missed.
just my 2 cents....
doc t.
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