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Triage walks back a 42-year-old male who has been stabbed in the left shoulder by his girlfriend (OK, I admit I am curious why, but first things first). He has bilateral breath sounds, but is not taking deep breaths due to pleuritic pain on the left side. Pulse oximetry is 98% on RA, and other vitals are normal. Heart tones are also normal, and you don’t palpate any subcutaneous air on the L side. The stab wound is just lateral to the scapula in the posterior axilla, with no local hematoma.

A portable CXR is taken (shown below). With pain meds on board, the patient’s symptoms are better. He asks to leave, stating, “I’m OK, she didn’t get anything important.”

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What does the X-ray show?
What is your next move?

Conclusion on next page

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