Haemodynamically unstable patient with chest trauma

A 47-year-old male patient presented to our hospital Accident and Emergency (A&E) department after involvement in a side impact motor vehicle accident. Notes from paramedics and witnesses described that the speed of the motorbike was around 50 km/h, and the patient was unconscious for a moment and later started speaking incoherently. The patient presented in A&E haemodynamically unstable, with a pulse rate of 110 beats/min, blood pressure of 80/50 mm Hg, and oxygen saturation of 92% on room air. He was confused and failed to respond to the questions from hospital staff. Clinically, the patient suffered from head and abdominal injuries, as well as a right lower limb fracture. Laboratory examinations were also performed and showed: HGB: 8.7 mg/dl, HCT: 26.3 mg/dl, CKMB: 1,88I U/L and CK: 3,274 IU/L. A multiphase CT angiography (CTA) and an aortography were performed immediately ( Fig. 1-6) .