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A 45-year-old male presents to the emergency department by ambulance from a motor vehicle accident. The emergency medical technician states that the patient had been the driver and was hit on the driver’s side while crossing over the intersection. The patient will open his eyes and withdraw from pain and but can only make sounds with no coherent words. The patient’s temperature is 97°F (36.1°C), blood pressure is 98/63 mmHg, pulse is 112/min, and respirations are 24/min with an oxygen saturation of 94% on 15 L/min O2 via a non-rebreather mask. Upon physical exam, you note reduced breath sounds on the left. The patient is stabilized and a chest radiograph is obtained, as shown in Figure A.What is the most likely pleural fluid finding?
Lymphocyte count of > 90% of total WBC
Presence of amylase
Protein fluid to serum ratio > 0.5
Triglycerides > 110 mg/dL
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A 24-year-old male is rushed to the emergency department after sustaining several gunshot wounds to the chest. He was found nonresponsive in the field and was intubated en route to the hospital. His vital signs are as follows: temperature is 98.8 deg F (37.1 deg C), blood pressure is 87/52 mmHg, pulse is 120/min, and respirations are 16/min. Physical examination is significant for decreased breath sounds and dullness to percussion over the right lung. A chest radiograph in the emergency department shows a large fluid collection in the right thoracic cavity. After aggressive fluid resuscitation is initiated, an emergent chest-tube was placed in the emergency department. The chest tube puts out 700 cc of frank blood and 300 cc/hr over the next 5 hours. A follow up post-chest tube insertion chest radiograph demonstrates significant residual right hemothorax. Which of the following is the next best step in management of this patient?
Clamp the chest tube
Place the chest tube to water seal
Remove the chest tube