I’m all out of breath

During the primary survey, the observations remain the same. Whilst examining the chest you note 6 stab wounds to both sides of the chest which are bubbling. The larger wound is examined and measures 5cm in diameter and is obviously drawing in air. The dressing is reapplied, and the remainder of the primary survey reveals superficial wounds to the backs of arms.

According to Advanced Trauma Life Support (ATLS) management, what is the next most appropriate step in this patient’s care?

You request a portable chest X-ray (image 1) in resus and as it is being performed you notice the patient becomes more breathless, gasping and oxygen saturations are now 89% on 15L O2.

The chest X-ray reveals a large left sided pneumothorax with slight mediastinal shift to the right. Surgical emphysema is visible along the left side of the chest and left side of neck.

Image 1 Case courtesy of Jeremy Jones, Radiopaedia.org, rID: 32564

What is the definitive treatment for this presentation?

A surgical chest drain is correctly sited on the left, away from the large open wound and the tension pneumothorax is resolved. On further discussion with the patient, she reveals her partner “lost their temper” and attacked her and left the home. She doesn’t know where he is and there is no one else at home with them.

What is the most important action you must take with this information?