Author: Emma Sian Carver / Editor: Jason L Louis / Reviewer: Tadgh Moriarty, Ciaran Mackle / Codes: CP1, CP2, RP4, SLO3, SLO4, TP3Published: 20/02/2024

A 47-year-old gentleman presented to the Emergency Department (ED) after being thrown off his horse. The horse had then kicked him in the back as he was lying on the ground. He complained of severe, sharp chest pain to the left side of his chest and back, which was worse on breathing in and prevented him from taking a deep breath. He did not otherwise feel short of breath. He was normally fit and well, a non-smoker and on no medication.

On examination, it was clear that he was in severe pain despite having received 22mg of intravenous morphine. He had bruising and tenderness over the left chest wall posteriorly. His respiratory rate was 36, with shallow respirations, sats 94% on air and the chest was clear to auscultation with equal vesicular breath sounds bilaterally.

His heart rate was 105, ECG showed sinus tachycardia and BP 136/87. A chest x-ray was performed to further assess his condition.


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