Scenario 3

A 56-year-old woman has jumped from a third floor window. Her supine chest x-ray is normal, except for a widened mediastinum. As part of her ongoing clinical evaluation you request a CT chest to exclude aortic injury. This demonstrates an occult right pneumothorax and bilateral basal atelectasis only (click on the CT to enlarge).

Does she require a chest drain?

No, provided she does not require IPPV in managing any other injuries [3]. The existence of the pneumothorax needs clear emphasis in the handover to in-house specialty teams, notably the anaesthetic team should they become involved in her care. You also need to document your handover discussion.