Abstract
A 25-year-old man with no medical history arrived to our emergency department 2 hours after a motor vehicle accident. On physical examination, he had multiple scars and bruises on his head, altered consciousness with a Glasgow Coma Scale of 13 points, a left pneumoneumothorax and a left lower-extremity deformity. The x-ray showed a closed left femur and 2 left rib fractures. He was treated with a left-side thoracic tube, early immobilization of the femur fracture and supportive care. After 16 hours, he suddenly developed dyspnea, having a room air oxygen saturation of 86%, which improved to 94% with 3L/min of nasal oxygen.
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