• Trauma to the thorax is often categorized as penetrating (i.e., gunshot wound, stab wound) or blunt (i.e., motor vehicle collision, fall). Bedside ultrasound is useful in the initial assessment of the patient with chest trauma to rapidly evaluate for pneumothorax and pericardial effusion as part of the extended focused assessment with sonography in trauma (eFAST).

• Penetrating injuries to “the box” (the area defined by the clavicles superiorly, nipple lines laterally, and costal margins inferiorly) are of particular concern because of the high likelihood of injury to the heart and mediastinal structures. The diaphragm may elevate as high as the fourth intercostal space on exhalation, so concurrent abdominal injury must be considered when penetrating trauma is located at or below the fourth intercostal space.

A 29-year-old G1P0 at 32 weeks’ gestation is brought in by ambulance to the A&E (E.R.) department in your tertiary trauma center following a road traffic accident. She was the restrained driver of a vehicle driving on an icy road at around 50 mph (80 km/h), when she lost control and had a frontal impact collision with another vehicle. She is healthy and has had an unremarkable pregnancy to date. On arrival, she is alert but appears anxious and uncomfortable. Her cervical spine is immobilized with a cervical collar and blocks, and she is on a spinal board. She complains of pains in her chest and lower abdomen. There is a bruise across her right forehead. Her vital signs show a sinus tachycardia of 115 bpm, blood pressure 87/62 mmHg, pulse oximetry 94% on room air, respiratory rate 28/min, and core temperature of 34.6°C. You are covering the birthing center and have been called urgently to the A&E department to assist in the management of this patient.