Case 3

A 24-year-old courier has been knocked from his bicycle by a van. He was struck from the side by the bumper and the van was travelling at approximately 30 mph. He was wearing a helmet and has been conscious throughout. 

He is complaining of severe leg pain and has an obvious left femoral fracture requiring large amounts of analgesia. 

As part of your routine survey, you noticed some left flank bruising and can elicit tenderness on palpation in the renal angle and left lower thoracic cage. However, this pain is much less severe than his leg.