A 25 year old man presented to the emergency department complaining of severe left chest pain associated with shortness of breath on waking. A chest radiograph showed a fracture of the left first rib. There was no history of recent direct trauma, although a minor injury to the left shoulder girdle had occurred three weeks earlier. Current theories on mechanism of injury in fractures of the first rib with both direct and indirect trauma are discussed and clinical management outlined.
Spontaneous pneumomediastinum has been commonly associated with recreational drug abuse. This often follows vigorous inhalation and the performance of a ritual valsalva-type manoeuvre. We describe a case of extensive pneumomediastinum and subcutaneous emphysema associated with intravenous drug abuse and bystander mouth-to-mouth resuscitation. This case presents a new dimension to the clinical presentation of illicit drug abuse, and supports the importance of appropriately learned Basic Life Support in high risk population groups.
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