A 40-year-old woman is brought in by EMS for evaluation of injuries secondary to being assaulted. She was out walking late last night when she was approached by two men who pushed her to the ground and began punching and kicking her repeatedly on her face, chest, and back. She is primarily complaining of chest wall and back pain.
Her medical history is significant for hypertension, diet-controlled diabetes, and “some sort of heart problem” for which she takes medication. Surgical history is significant for hysterectomy, cholecystectomy, and appendectomy. She smokes more than a pack of cigarettes per day and consumes at least a six-pack of beer daily.
Initial exam shows an anxious female who appears somewhat uncomfortable but is in no obvious distress. Her vital signs are as follows: blood pressure, 130/88 mm Hg; pulse, 120 beats/min; respiratory rate, 22 breaths/min; and O2 saturation, 100% on room air.
Physical exam reveals extensive facial/periorbital swelling, as well as swelling in the neck. Some splinting is noted. There is extensive crepitus noted within the soft tissue of the face, neck, and chest wall. Also, there is moderate tenderness bilaterally over the ribs.
Chest radiograph is obtained (shown). What is your impression?
