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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.”
What does the X-ray show?
What is your next move?
Conclusion on next page