Question

RTA- absent air entry on left side. Tenderness in left lower chest wall. Next step in EMR

• A. X-ray
• B. CT
• C. FAST
• D. DPL

Answer 1

The Correct Option is C

In the scenario described, we are dealing with a suspected traumatic injury due to a road traffic accident (RTA). The presence of absent air entry on the left side and tenderness in the left lower chest wall suggests the possibility of a pneumothorax or hemothorax. In emergency medical settings, it is crucial to assess for life-threatening injuries rapidly and effectively. Here are the steps and reasoning for selecting the next step in emergency medical response (EMR):

• Clinical Signs: The physical examination findings of absent breath sounds on the affected side and chest wall tenderness can be indicative of chest trauma, which may include conditions like pneumothorax, hemothorax, or rib fractures.
• FAST Examination: The Focused Assessment with Sonography for Trauma (FAST) is a bedside ultrasound examination that is used to detect free fluid (indicative of internal bleeding) in the abdominal cavity and pericardial space. It is a rapid and non-invasive procedure that can be immediately performed in the emergency department to provide quick diagnostic information.
• Immediate Need for Action: In trauma settings, time is of the essence. The FAST exam can quickly confirm or rule out the presence of a hemothorax by identifying fluid in the thoracic cavity. This information is critical to guide further management, such as chest tube insertion if a hemothorax is confirmed.

Given these considerations, the most appropriate next step in the emergency medical response is performing a FAST exam. This choice balances speed, effectiveness, and the crucial need for immediate actionable diagnostic information to manage the patient's condition promptly.