A 20s M is bib ems s/p ped struck. According to the pt, he was clipped by a car who then dragged him for an unknown distance. He then got up and ran to a store to get help. On arrival, his complaint is L shoulder pain. His vital signs are normal and his sat is 100. He talks normally, breath sounds are normal, pulses are strong. IVs are placed.
There is a bruise over his L anterior shoulder / chest wall and a larger bruise over his L posterior chest wall. He has some mild L rib tenderness over the bruise. His clavicle, shoulder appear intact, but he complains of pain when he moves his shoulder.
The remainder of the physical are normal. There is no head injury; the Cspine is not tender; the belly is soft and non-tender; and he moves all his extremities spontaneously. An eFast, cxr, and pelvis xr are normal. Repeat vital signs are also normal. What shall we do next?
Given persistent tenderness and ecchymosis on his chest, I wouldn’t stop at a chest x-ray (probably portable in this situation in the trauma bay) and would consider getting a CT chest to better image his ribs and shoulder. I would also get EKGs and CEs to evaluate for blunt cardiac injury. L shoulder pain after trauma could also be Kehr’s sign- consider CT abdomen/pelvis if no other etiology found?