On arrival at the emergency room, his vital signs were as follows: temperature, 36.2 °C; pulse, 68 beats per minute with an irregular rhythm; respiratory rate, 24 breaths per minute; blood pressure, 143/64 mmHg; and oxygen saturation, 100% on 6 L/minute with a simple oxygen mask. His status on the Glasgow Coma Scale was 13 (E3V4M6), indicating slightly affected consciousness due to mild brain injury.
On examination, he was found to be drowsy, pale, and restless. His heart sounds were unremarkable. Cardiac apex was not palpable. His trachea was central and left-sided chest expansion was reduced. There was significant left-sided chest tenderness. Coarse crackles were heard with decreased breath sounds over the left side of his chest. His abdomen was not distended. There was no hepatosplenomegaly. His cranial examination was normal.
His limbs examination was normal except for his left arm which had a bruise. Arterial blood gas (ABG) analysis revealed the following: pH, 7.38; partial pressure of carbon dioxide (PCO2), 30 mmHg; partial pressure of oxygen (PO2), 211 mmHg; bicarbonate (HCO3−), 17.5 mmol/L; base excess, − 6.5 mmol/L; hemoglobin, 12.2 g/dL; and lactate, 6.0 mmol/L.
Chest radiography and computed tomography (CT) revealed left hemothorax with fractures of the 9th to 12th ribs, which we suspected was associated with the injury sustained during his first fall 3 days before admission.
His blood pressure gradually decreased to 93/45 mmHg after CT assessment, and intensive fluid resuscitation was then initiated. Contrast-enhanced CT (CECT) 4 hours later showed worsening hemothorax with contrast extravasation in the region supplied by the tenth intercostal artery. A tube thoracostomy at the fifth intercostal space initially drained 950 mL of hemothorax. TAE resulted in hemodynamic stabilization.