His blood pressure is taken again and is now a bit higher. His neuro exam appears normal. No apparent neck or back injury. With his stethoscope, the doctor hears some crackling sounds around the left lung. The patient's chest is slightly bruised but the doctor hears no unusual sounds from the heart.
Pulse is strong.
The doctor orders x-rays of the neck, spine, chest and pelvis. When the ER doctor looks at the chest x-ray, he is surprised to find signs of traumatic aortic disruption, a potentially fatal heart injury. Traumatic aortic disruption is caused by the shearing forces of high-speed front and side impact automobile accidents and by falls from great heights that tear the aorta away from the heart. The ER staff normally sees cases where the aorta is only partially disrupted because a complete disruption will kill a victim within moments of the accident, usually at the scene. Unlike broken bones or bleeding wounds, partial aortic injury can be difficult to detect for a harried ER doctor.