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Fri Aug 31 13:51:14 BST 2007

In a message dated 8/31/2007 2:47:51 P.M. W. Europe Daylight Time,  
pbjorn at emh.org writes:

Something like ninety per cent of penetrating chest trauma is  treated
with a single chest tube.  Start there.  He's got a  pneumo on the right.

Question is, do you wait for a CXR given his  history, or insert the tube
first and save on the extra film?

I'm  doubtful that the little circle in his mediastinum is a bullet.
Doesn't  look dense enough, and it's too symmetrical.  Looks more like a
button  (or a spent casing, end-on).  And so as to prove conclusively
that I  have no aptitude for radiology: his stomach silhouette looks odd
to  me.  Any chance the trajectory was downward?

No doctor, me.   And the world is better for it.

Pret

pret dr roentgen would be most impressed. 

the metallic object is the connector of the monitor leads on the chest. 

what no one has mentioned is the subcutaneous air on the LEFT side of the  
neck, subtle but definitely visible on the original  image.

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GSW TO RIGHT CHEST. WHAT IS THE WORKUP OF THIS CASE