Board Review: Lets get some air


A 42-year-old male with past medical history of hypertension presents to the ED with dyspnea on exertion. The patient was seen last week in the emergency room after being involved in the car accident where his chest hit the steering wheel. Patient suffered 2 right and 1 left sided rib fractures but had a normal pulse ox and was sent home with an incentive spirometer. Patient today with bilateral chest pain but no fever or cough. Patient has a normal EKG without any new ST-T wave changes. The patient has the following vitals: T- 99.2; HR- 130; RR- 24; SpO2- 69% on RA; BP- 165/70. On exam, patient has bilateral diffuse crackles. Patient is placed on a NRB and pulse ox improves to 72%. What is the primary cause of patient’s respiratory distress? 



A. Pneumothorax

B. Pneumonia

C. Acute Respiratory Distress Syndrome

D. Congestive Heart Failure

















Answer C. Patient does not have a Pneumothorax on the chest xray although commonly associated with multiple rib fractures. Patient also despite having past medical history of hypertension does not exhibit signs of cardiogenic pulmonary edema. Additionally, pneumonia maybe a common sequale to rib fractures, the interstitial pattern on chest xray is consistent with ARDS. 



Farkas, J. "ARDS vs. pseudoARDS – Failure of the Berlin definition." 2018. <>. 4/13/2020