CXR Quiz 2
14 year old is riding his bike when he falls, landing on the handle-bars. He has bruising in his epigastric region. hat does the X-ray show, and what is your initial management?
The X-ray demonstrates free air under the diaphragm, most likely representing a bowel perforation. This is a profound amount of air, suggesting stomach is the likely organ injured.
There is also a small fluid level evident on the right side suggesting intra-peritoneal bleeding or the leak of gut contents.
Initial management includes attention to airway, breathing and circulation, with establishment of large bore IV access and intravenous fluid resuscitation (and potentially blood transfusion) as required. Immediate surgical review is required. An initial trauma review is necessary to exclude additional life-threatening injuries that can be easily overlooked.
If the patient is stable, CT is advised to delineate injuries further before going to theatre for definitive management. A full trauma review to exclude additional injuries, supportive care and antibiotic therapy will then be required.
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