A 62-Year-Old Man with Aortic Dissection and Flail Chest

A 62-year-old man was taken by advanced life support ambulance to a local community hospital with respiratory distress after being struck by a truck in a restaurant parking lot. Witnesses stated that the patient was attempting to walk to his car when he fell to the ground and was run over by a pickup truck. The patient said he felt like he was going to faint, and he lowered himself to the ground. He believed the driver of the truck did not see him and drove over him. The paramedics arrived and transported the patient to a rural community hospital. He was complaining of left-sided chest pain, difficulty breathing, and dizziness. His initial vital signs were a pulse of 110 beats/min, blood pressure of 122/64 mm Hg, and oxygen saturations of 88%. Upon arrival to the hospital, the patient began to decompensate, with his heart rate increasing to 134 beats/min and his systolic blood pressure dropping to 92 mm Hg. The attending physician called for air medical transport to the nearest trauma center. Advanced trauma life support (ATLS) was initiated. Michelle M. McLean, MD, EMT-P, is medical director at LifeNet of Michigan, Air Methods Corporation in Saginaw, MI. Jason Bunn, MD, is an emergency medicine resident (postgraduate year 2) at Central Michigan University in Mt Pleasant, MI. Aaron Wasserman, MD, is an emergency medicine resident at Central Michigan University. Peter V.R. Tilney, DO, FACEP, EMT-P, is a board-certified emergency physician at Central Maine Medical Center in Lewiston. He is also a medical director for LifeFlight of Maine and can be reached at [email protected]