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Assembly

Hypoxemia After a Road Traffic Accident in Kenya

Author
B Jason Brotherton, MD, MS1,2; Robert Kivindu, MBChB1; Kristina E. Rudd, MD, MPH3

1Department of Internal Medicine, Kijabe Hospital, Kijabe, Kenya
2Department of Critical Care, Kijabe Hospital, Kijabe, Kenya
3Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA


Case

A previously healthy 22-year-old woman was transferred to our hospital in rural Kenya from an outside facility for a higher level of surgical care. One day prior to transfer she was involved in a road traffic accident, where she was a passenger on the back of a motorcycle. She sustained fractures of her right ischium, midshaft of the right femur, and distal right tibia and fibula. No other injuries were reported.

Shortly after arrival to our hospital she was noted to become newly tachypneic and hypoxemic. Vital signs at that time were the following: blood pressure 107/51 mm Hg, pulse 112 beats/min, respiratory rate 28 breaths/min, peripheral capillary oxygen saturation breathing ambient air 84%, and Glasgow Coma Scale 15. A computed tomography (CT) scan with intravenous contrast of the chest was obtained (Figures 1a, 1b) and a diagnosis was made.

A computed tomography (CT) scan with intravenous contrast of the chest

Question

Based on the history and CT findings, what is the most likely diagnosis?

A. Pulmonary embolism
B. Aspiration pneumonia
C. Fat embolism
D. Pulmonary contusion

Answer