Man with Altered Mentation after Trauma

A 37 year-old male presented after an altercation in which he was dragged by a vehicle. The patient was intoxicated and asking repetitive questions. He demonstrated significant facial trauma—including frank bloody discharge from both ears and dental trauma. His vitals signs were as follows: Temperature 36.8 C; Blood pressure: 125/88; Heart rate: 90; Respiratory rate: 24; O2 sat: 100% room air. His portable chest x-ray can be seen below (Figure 1). Secondary to his mechanism, intoxication, and chest radiograph results, he was sent for computed tomography (CT) imaging. Immediately post CT, his imaging was reviewed (Figure 2). Shortly thereafter, the patient’s altered mentation worsened and he acutely decompensated.