Haste Makes Waste

A woman who looks to be 30 years old is brought to your facility as a trauma code following a car accident. She was a restrained driver, traveling at a high speed when she lost control of her vehicle and hit a retaining wall.

When first responders arrived, the patient had extricated herself but demonstrated a decreased level of consciousness, severe respiratory distress, and a Glasgow Coma Scale score of 7. She was intubated at the scene by emergency medical personnel.

On evaluation, you note a young, intubated, unresponsive female. Her blood pressure is 90/50 mm Hg; heart rate, 90 beats/min; and O₂ saturation, 100%. Rapid primary survey shows no obvious injury or deformity apart from what appears to be a seat belt sign.

A portable chest radiograph is obtained (shown). What is your impression?