A patient who came with history of fall while boarding a running local train under effect of alcohol
He was brought to the hospital after 2 hours of injury by the local police
When he came he was very restless and agitated
There were no signs suggestive of any head injury
Only sign we were able to elicit was marked tenderness over Right side of chest
There were no obvious dilated veins over the neck, though a slight tracheal deviation was present
A chest xray showed
-Over expanded Right hemithorax
-Shift of the mediastinum to the left side
-Depression of the Right hemidiaphragm
SPO2 was 78%. Immediately a needle thoracostomy was done. The SPO2 increased to 94%.
An intercostal drain with under water seal was inserted.
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